Summary
Definition
History and exam
Key diagnostic factors
- concordant mechanism of injury
- neck pain
- sacral sparing
- associated traumatic injury
- posterior cervical tenderness
Other diagnostic factors
- male sex
- age 18 to 25 years
- intoxication
- numbness, tingling, or weakness of extremities
- bowel or bladder dysfunction
- motor weakness
- sensory loss
- reduced or painful cervical range of motion (ROM)
- loss of anorectal tone and perianal sensation
- spasticity
- hyperreflexia
- Babinski sign
- Hoffman sign
- neurogenic shock
- spinal shock
- respiratory change
- cranial nerve deficit
Risk factors
- male sex
- female sex (whiplash injury)
- 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
- axial CT cervical spine with 3D reconstructions
Investigations to consider
- cervical spine x-ray series
- MRI cervical spine
- CT myelogram
- CT angiography (CTA) and MR angiography (MRA)
- flexion-extension (F/E) cervical spine x-rays
- nerve conduction studies
- electromyography
Treatment algorithm
acute neck pain with altered neurological status: at initial presentation
low probability of neurological injury: following initial assessment
high probability of neurological injury: following initial assessment
Contributors
Authors
Christopher S. Ahuja, MD

Research Fellow
Division of Neurosurgery
Department of Surgery
University of Toronto
Ontario
Canada
Disclosures
CSA declares that he has no competing interests.
Fan Jiang, MD, FRCS(C)
Clinical Associate
Division of Neurosurgery
Department of Surgery
University of Toronto
Ontario
Canada
Disclosures
FJ declares that he has no competing interests.
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
Ontario
Canada
Disclosures
MGF has served as a consultant for Fortuna Fix. MGF is an author of a reference cited in this topic.
Acknowledgements
Dr Christopher S. Ahuja and Dr Michael G. Fehlings would like to gratefully acknowledge Dr Narihito Nagoshi, Dr Hiroaki Nakashima, Dr David W. Cadotte, and Dr Jefferson R. Wilson, previous contributors to this topic. NN, HN, DWC, and JRW declare that they have no competing interests.
Peer reviewers
Jwalant Mehta, MS Orth, D Orth, MCh Orth, FRCS (Tr & Orth)
Consultant Orthopaedic and Spinal Surgeon
BMI Werndale Hospital
Carmarthen
Carmarthenshire
UK
Disclosures
JM has been provided with educational support for attending conferences by Medtronic, Depuy Spine UK, and Nuvasive.
Alpesh Patel, MD
Assistant Professor
Orthopedic Surgery Operations
Department of Orthopedics
University of Utah
Salt Lake City
UT
Disclosures
AP is an author of a reference cited in this topic.
Differentials
- Nontraumatic neck pain
- Degenerative cervical spine disease
- Acquired torticollis
More DifferentialsGuidelines
- Head injury: assessment and early management
- ACR Appropriateness Criteria: Suspected spine trauma
More GuidelinesPatient leaflets
Whiplash
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer