This article critically examines the incidence of cervical spine injuries in head-injured patients. The biomechanics of cervical spine injuries are summarized. The clinical clues that lead to the suspicion of spinal cord injury in an unconscious patient are described. Controversies surrounding the extent of radiological work up that is necessary in an unconscious patient "to clear the spine" are presented. The article closes with a brief outline of initial management of patients with spinal injury.

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