{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:51:13Z","timestamp":1782489073378,"version":"3.54.5"},"reference-count":9,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,3,12]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>Cervical spine clearance in trauma patients is frequently guided by strict protocols, particularly when patients present with midline cervical tenderness or cannot be reliably examined. Although a normal CT scan is often used to justify cervical collar removal, subtle but clinically significant injuries may be missed. This case report describes a polytrauma patient with altered consciousness in whom a C5\/C6 bilateral facet dislocation was initially overlooked on CT imaging. A retrospective review revealed a subtle avulsion fragment, which was indicative of the underlying injury. This case highlights the limitations of CT alone for cervical spine clearance. While the CT-based protocols may reduce healthcare costs and streamline patient management, they carry the risk of missing critical injuries. In high-risk patients, continued immobilisation and additional imaging, such as MRI, are essential to prevent potentially serious neurological complications.<\/jats:p>","DOI":"10.1136\/bcr-2025-267458","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T16:05:13Z","timestamp":1775145913000},"page":"e267458","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Missed subtle radiological sign on cervical computed tomography"],"prefix":"10.1136","volume":"19","author":[{"given":"Kai Hean","family":"Teh","sequence":"first","affiliation":[{"name":"Orthopedic Department, Hospital Queen Elizabeth, Kota Kinabalu, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8932-6215","authenticated-orcid":false,"given":"Han Sim","family":"Lim","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Hospital Pulau Pinang, Georgetown, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamarul Bahrin","family":"Zairul Anuar","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Penang General Hospital, Georgetown, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khin Maung","family":"Ohn","sequence":"additional","affiliation":[{"name":"Surgery, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"2026062608151281000_19.4.e267458.1","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1007\/s11999-012-2286-7","article-title":"Spinal cord injury resulting from injury missed on CT scan: the danger of relying on CT alone for collar removal","volume":"470","author":"Gebauer","year":"2012","journal-title":"Clin Orthop Relat Res"},{"key":"2026062608151281000_19.4.e267458.2","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1302\/2058-5241.5.190047","article-title":"Cervical spine clearance after blunt trauma: current state of the art","volume":"5","author":"Moeri","year":"2020","journal-title":"EFORT Open Rev"},{"key":"2026062608151281000_19.4.e267458.3","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-018-0988-3"},{"key":"2026062608151281000_19.4.e267458.4","doi-asserted-by":"crossref","first-page":"429","DOI":"10.7326\/M14-2351","article-title":"Cervical Spine Clearance in Obtunded Patients After Blunt Traumatic Injury","volume":"162","author":"Badhiwala","year":"2015","journal-title":"Ann Intern Med"},{"key":"2026062608151281000_19.4.e267458.5","first-page":"1","article-title":"The value of magnetic resonance imaging in addition to computed tomography of the cervical spine in the obtunded or blunt trauma patient: a systematic review","volume":"46","author":"Joaquin","year":"2020","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2026062608151281000_19.4.e267458.6","first-page":"1893","article-title":"The use of MRI in the management of the obtunded blunt trauma patient with a negative CT scan: a survey of practice patterns of US trauma centers","volume":"19","author":"Schoenfeld","year":"2019","journal-title":"Spine J"},{"key":"2026062608151281000_19.4.e267458.7","article-title":"Clearing the cervical spine in the obtunded adult trauma patient: a systematic review","volume":"14","author":"Khan","year":"2022","journal-title":"Cureus"},{"key":"2026062608151281000_19.4.e267458.8","doi-asserted-by":"crossref","first-page":"3127","DOI":"10.1007\/s00586-025-08787-z","article-title":"Computed tomography versus magnetic resonance imaging of the cervical spine in the spinal clearance of trauma patients: a systematic review and meta-analyses","volume":"34","author":"Yong","year":"2025","journal-title":"Eur Spine J"},{"key":"2026062608151281000_19.4.e267458.9","doi-asserted-by":"crossref","DOI":"10.1136\/tsaco-2016-000016","article-title":"Impact of MRI on changing management of the cervical spine in blunt trauma patients with a \u2018negative\u2019 CT scan","volume":"1","author":"Mohamed","year":"2016","journal-title":"Trauma Surg Acute Care Open"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-267458","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:21:06Z","timestamp":1782487266000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-267458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":9,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,2]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bcr-2025-267458"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-267458","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}