Despite the fact that we are living in the era of spiral CT and multidetector spiral CT allowing us to scan the whole spine in less than a minute and to make high quality multiplanar reformatted images, plain films remain important in clearing the spine of polytraumatised patients. Particularly hemodynamic unstable patients that must be urgently transferred to the operation room need to be rapidly cleared for (cervical) spine lesions, without being transported to the CT unit which is--in most hospitals--located relatively far away from the emergency room and the operation rooms. In these patients, for the time being, spiral CT cannot replace conventional radiographs for the detection of sometimes subtle lesions. Knowledge of the direct but also the indirect signs of fractures remains important in the evaluation of these plain films. This article demonstrates some of these sometimes subtle signs that can help in making the diagnosis of these lesions.