Last reviewed: 19 Sep 2021
Last updated: 02 Nov 2020



History and exam

Key diagnostic factors

  • concordant mechanism of injury
  • neck pain
  • risk factors

Other diagnostic factors

  • reduced level of consciousness
  • paraesthesia in the limbs
  • motor weakness
  • sensory loss
  • bowel or bladder dysfunction
  • priapism
  • cranial nerve deficit
  • Hoffman's sign
  • Babinski's sign

Risk factors

  • male sex
  • female sex (whiplash injury)
  • age 18-25 or >65 years old
  • a dangerous mechanism of injury
  • distracting traumatic injuries
  • lack of preparation or awareness of collision
  • head rotated at time of collision
  • previous cervical spine trauma or surgery
  • pre-existing spinal, cranial, or other abnormality

Diagnostic investigations

1st investigations to order

  • high-resolution CT cervical spine

Investigations to consider

  • CT whole spine
  • MRI cervical spine

Treatment algorithm


Expert advisers

Muhammad Dherijha, MBBS, MRCS

ST8 Neurosurgery

Health Education Northwest

Manchester Clinical Neuroscience Centre




MD declares that he has no competing interests.


BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:

Christopher S. Ahuja, MD

Research Fellow

Division of Neurosurgery

Department of Surgery

University of Toronto



Michael G. Fehlings, MD, PhD, FRCS(C), FACS

Professor Division of Neurosurgery

Director of Neuroscience Program

University of Toronto

Krembil Chair in Neural Repair and Regeneration

Medical Director

Krembil Neuroscience Center

Toronto Western Hospital




CSA declares that he has no competing interests. MGF served as a consultant for Zimmer, In Vivo Therapeutics, and Pfizer. He receives institutional fellowship grant support from AOSpine, Medtronic, and Depuy-Synthes.

Peer reviewers

Jonathan Lucas, MBBS, FRCS (Eng), FRCS (Orth&Tr)

Head of Service - Paediatric Spinal and Orthopaedic Surgery

Consultant Spinal Surgeon

Guys and St Thomas’ NHS Foundation Trust

Evelina London Children’s Hospital

Guys Hospital




JL is an Education Consultant to Nuvasive Inc. in the subject of paediatric spinal deformity surgery.


Helena Delgado-Cohen,

Section Editor, BMJ Best Practice


HDC declares that she has no competing interests.

Susan Mayor,

Lead Section Editor, BMJ Best Practice


SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice


RW declares that she has no competing interests.

Annabel Sidwell, null

Comorbidities Editor, BMJ Best Practice


AS declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice


AM declares that he has no competing interests.

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