Last reviewed: June 2020
Last updated: January  2018



History and exam

Key diagnostic factors

  • concordant mechanism of injury
  • neck pain
  • sacral sparing
  • associated traumatic injury
  • posterior cervical tenderness

Other diagnostic factors

  • male gender
  • 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 gender
  • female gender (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
More 1st investigations to order

Investigations to consider

  • cervical spine x-ray series
  • MRI cervical spine
  • flexion-extension (F/E) cervical spine x-rays
  • nerve conduction studies
  • electromyography
More investigations to consider

Treatment algorithm


Christopher S. Ahuja

Research Fellow

Division of Neurosurgery

Department of Surgery

University of Toronto




CSA declares that he has no competing interests.

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 served as a consultant for Zimmer, In Vivo Therapeutics, and Pfizer. He receives institutional fellowship grant support from AOSpine, Medtronic, and Depuy-Synthes. MGF is an author of a reference cited in this monograph.

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 monograph. NN, HN, DWC, and JRW declare that they have no competing interests.

Peer reviewersVIEW ALL

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.

Assistant Professor

Orthopedic Surgery Operations

Department of Orthopedics

University of Utah

Salt Lake City



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

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