Immobilisation is a crucial part of the management of a trauma patient. This case describes the importance of stabilisation and early imaging in preventing long-term disability. The patient presented with no history or symptoms suggestive of spinal instability, but was under the influence of alcohol and had signs which were difficult to explain. After deterioration in his vital signs, he was found to have a rare and spectacular assembly of injuries which could have proved devastating had immobilisation been compromised. A comprehensive literature search was undertaken to establish the current consensus on the timing of mobilisation and imaging.
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