Cervical Hyperextension Injuries



  • Class of neck injuries typically seen in rapid, forceful extension of the cervical spine
  • Flexion–extension injuries (“whiplash”) are usually from motor vehicle accidents (MVAs), typically side-impact or rear-end collisions.
  • Other causes include falls, violence, or sports-related injuries (1).
  • May involve:
    • Injury to vertebral and paravertebral structures: fractures, dislocations, ligamentous tears, and disc disruption/subluxation
    • Spinal cord injury (SCI): traumatic central cord syndrome (CCS) secondary to cord compression or vascular insult, SCI without radiologic abnormality (SCIWORA)
    • Blunt cerebrovascular injury (BCVI): vertebral artery or carotid artery dissection
    • Soft tissue injury: cervical strain/sprain (i.e., whiplash), cervical stingers (See “Brachial Plexopathy.”)


  • Predominant age: SCI average age of injury is 43 years; CCS average age is 53 years.
  • High-energy trauma (e.g., road accidents) and sports injuries are more common in young adults (average age is 29 years), whereas low-energy trauma (e.g., falls) are usually implicated in the >65 years age group
  • Most (~80%) new SCI cases are male (1).

In the United States

  • Cervical fractures: 2 to 5/100 blunt trauma patients
  • CCS: 4/100,000 people/year
  • BCVI: estimated 1/1,000 of hospitalized trauma patients; incidence increased with cervical spine or thoracic injury
  • Cervical strain: 3 to 4/1,000 people/year
  • Whiplash is the most common injury in MVAs and accounts for 28% of all ED visits for MVAs.
  • Incidence of whiplash is 70 to 328/100,000 with rates highest in 20- to 24-year-old females.
  • 2–6% of patients with blunt trauma have SCI. 80% are below the C2 level (2).
  • The incidence of traumatic SCI is approximately 54 cases per million population per year (1).

Etiology and Pathophysiology

Blunt trauma due to MVAs, falls, sports injuries, and violence (primarily gunshot wounds)

Risk Factors

  • Whiplash: initial injury, no seat belt use, low neck rest, female gender (thinner necks)
  • Chronic pain and/or disability: litigation, previous neck pain or injury, female gender, report of headache/low back pain at onset, low education level (3)[C]
  • Fractures: osteoporosis, conditions predisposing to spinal rigidity, such as ankylosing spondylitis or other spondyloarthropathies
  • CCS: preexisting spinal stenosis present in >50%
    • Acquired: prior trauma, spondylosis
    • Congenital: Klippel-Feil syndrome (congenital fusion of any two cervical vertebrae)

General Prevention

Seat belts, rule changes, proper technique, and proper use of protective equipment for sports activities can prevent or minimize injury.

Commonly Associated Conditions

Closed head injuries, whiplash-associated disorders (WADs), SCI, soft tissue trauma

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