Missed subtle radiological sign on cervical computed tomography

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.