Editor,—We read with interest Mike Clancy's comprehensive review of clearing the cervical spine in adult trauma victims.¹ It highlights the current diverse methods of treating cervical spinal injury in the UK and USA, the difficulties of confidently excluding an unstable cervical spine injury in unconscious patients, and the problems associated with unnecessary cervical spine immobilisation. We report our initial experience with the use fluoroscopy to dynamically clear the cervical spine in obtunded patients.

Since 1994 the following protocol has been adopted by the trauma service in Oxford for clearing the spine in the unconscious trauma patient. Anteroposterior and lateral radiographs are taken of the cervical, thoracic and lumbar spines, which may include one attempt at a swimmer's or an oblique view if the cervicothoracic junction is not seen. All patients undergo computed tomography of C1 and C2 cervical vertebrae, as well as at C7 and T1 if the cervicothoracic junction is not adequately visualised. The open mouth “peg view” is extremely difficult to …