Cervical spine fractures are potentially deadly conditions that arise after trauma, exaggerated extension or flexion. Gravity depends on the location, stability, and pattern of the injury.
Patients present with symptoms like pain located on the posterior side of the neck, spontaneous or induced by palpation, leading to a decrease of the motion range and paresthesias in the territories of the affected nerves. Neck muscles may be spastic  and tender and an ecchymosis may be present at the fracture site. Muscular spasticity may be persistent if the condition remains undiagnosed . Vertebral malalignment may be visible or palpable.
Clinical examination may find one or more of the following: spinal or neurogenic shock, hypotension with paradoxical bradycardia, fecal incontinence, urinary retention, ileus, priapism, poikilothermia, areflexia, flaccidity, weakness or paresthesias of the arms or legs. Pain may also radiate to the arms and legs and be associated with proprioceptive deficiency and deep tendon reflex loss if spinal cord injury exists. In this case, patients also have difficulty breathing. Distal pulses remain uncompromised.
Unstable fractures are characterized by involvement of more than one vertebral column and increased intervertebral disc space height or interspinous distance. The intervertebral disc space height may also be increased, with having the same significance.
Clinical examination can observe specific cord syndromes. Central cord syndrome is characterized by greater upper extremity deficit compared to lower limb impairment. In anterior cord syndrome, patients present with paralysis that sets in immediately after the injury, while posterior cord syndrome causes disruption of the dorsal nervous columns. Complete spinal cord injury has the worse prognosis and consists of a complete absence of motor and sensorial function.
A frequent type of injury after automobile accidents is whiplash, that may become symptomatic immediately or 6-12 hours afterward. Accuses consist of neck, jaw, interscapular, shoulder or arm pain, reduced motion range of the neck, headache, vertigo, nausea, vision abnormalities and paresthesia in the arms and legs, as well as dysphagia caused by a retropharyngeal hematoma. In this case, neurologic examination reveals reflex hyperactivity and abnormal plantar response .
While evaluating a suspected cervical spine fracture patient, the clinician should not forget to evaluate cranial nerves . The patient should be alert during the examination, and even if so, neurological examination sensitivity may be inadequate , therefore clinical protocols should be followed  and injury severity score should be calculated .
Although patients may have no complaints related to neck tenderness, they need to have a radiological evaluation if they have a neurologic deficit, altered sensorial function or other significant injuries, according to Canadian C-Spine Rules and National Emergency X-Radiography Utilization Group  . These rules also apply to children. If sitting and walking are possible and the patient can rotate the head by 45 degrees both ways, the level of suspicion of cervical fracture is diminished.
On the other hand, computer tomography examination is urgent if the patient has a Glasgow coma scale below 13, has been intubated or a rapid diagnosis is needed.
When the radiological evaluation is considered necessary, all classical five views should be ordered: anteroposterior, oblique, odontoid, swimmer's and cross-table lateral. If available, a computer tomography  or magnetic resonance imaging  examination is useful, being more sensitive. Magnetic resonance is superior in describing ligament and disc lesions. Even if symptoms are limited to the cervical spine, motor vehicle accident victims should have the whole spine examined if a cervical spine fracture is demonstrated . Furthermore, the clinician should keep in mind that C1-C3 spine fractures may be associated with vertebral artery injury .