Acute cervical spine trauma

Last reviewed: 1 Mar 2023
Last updated: 21 Oct 2022



History and exam

Key diagnostic factors

  • concordant mechanism of injury
  • neck pain
  • sacral sparing
  • associated traumatic injury
  • posterior cervical tenderness
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • male 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
More risk factors

Diagnostic investigations

1st investigations to order

  • multidetector computed tomography (MDCT) axial CT cervical spine with 3D reconstructions
More 1st investigations to order

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
More investigations to consider

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



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


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




MGF has served as a consultant for Fortuna Fix. MGF is an author of a reference cited in this topic.

Karlo M. Pedro, MD

Clinical Spine Fellow

Division of Neurosurgery

Department of Surgery

University of Toronto




KMP declares that he has no competing interests.


Dr Michael G. Fehlings, and Dr Karlo M. Pedro would like to gratefully acknowledge Dr Narihito Nagoshi, Dr Hiroaki Nakashima, Dr David W. Cadotte, Dr Jefferson R. Wilson, Dr Christopher S. Ahuja, and Dr Fan Jiang, previous contributors to this topic.


NN, HN, DWC, JRW, CSA, and FJ 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





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



AP is an author of a reference cited in this topic.

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  • Calculators

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