Major injuries of the cervical spine are usually caused by indirect such as falls onto the head or other violent movements transmitted from the skull The mechanism may be an excessive movement in any d extension, lateral flexion or rotation-or a vertical compression force acting upon a straight spine. The nature of the injury bears a fairly constant relation- ship to the mechanism of its causation, but it should be appreciated that many injuries are caused by a combination of forces rather than by violence acting in a single direction. Flexion and flexion-rotation injuries are common: flexion alone tends to cause a wedge compression fracture(Fig. 8.1A), whereas combined flexion rotation cause subluxation(Fig. 8.1B), dislocation(Fig. 8 ic) or fracture- dislocation. A flexion or flexion-rotation force may also cause massive d placement of an intervertebral disc, without bone injury Fig. of the atlas A force may fracture the neural arch, especially may fracture the dens(odontoid process) of the axis. Alternatively, hyperextension may the anterior longitudinal ligament and the annulus fibrosus, forcing the vertebral bodies apart anteriorly spine, in subluxation) (Fig. 8.2). Hyperextension of an osteoarthritic cervical lead to which the spinal canal is already by osteophytes, may damage to the spinal cord through impingement upon it infolded piees of results in the so-called flavum the osteophytes characteristic incomplete'central cord syndrome', with loss of neurological function. cause a fracture of the Vertical compression acting through the skull may body(Fig. 8.3) ring of the atlas(see Fig 8.11) or a burst fracture of a vertebral