Fracture of the Neck (Cervical Spine Fracture)

First aid for a suspected broken neck

1. Call 911 or your local emergency number.
2. Do not move the person unless they are in immediate danger (fire, traffic, drowning).
3. Kneel behind their head and hold it gently still in the position you found it, in line with the body, until help arrives.
4. Do not remove a helmet unless necessary to clear the airway.
5. If the person must be moved, or vomits, log-roll them with the head, neck and body kept in line, ideally with several helpers.
6. If they stop breathing, start CPR, keeping head movement to a minimum.

Anatomy and types of fracture

The cervical spine has seven vertebrae. C1 (atlas) and C2 (axis) at the top allow nodding and turning. C3 to C7 below support the neck. The spinal cord passes through the center, and nerves controlling breathing (C3 to C5) and the arms exit here.

Stable fractures are unlikely to shift. Unstable fractures can move and damage the spinal cord and need urgent immobilization and often surgery.

Note: "neck fracture" can also refer to a break of the femoral neck (hip). This page covers the cervical spine.

Symptoms

• neck pain, often severe, worse with movement
• tenderness in the middle of the back of the neck
• muscle spasm and stiffness
• bruising and swelling
• pain spreading to the shoulders or arms

Signs of spinal cord or nerve injury:

• numbness, tingling or burning in the arms or legs
• weakness or paralysis
• loss of bladder or bowel control
• difficulty breathing with high injuries
• low blood pressure and slow heart rate (neurogenic shock)

Some people, especially with alcohol intoxication or other painful injuries, may not feel neck pain, which is why trauma teams protect the neck until it is cleared.

Diagnosis

Clinical decision rules, such as the Canadian C-Spine Rule and NEXUS criteria, help decide who needs imaging. Imaging includes:

• CT scan: the main test for fractures after significant trauma
• MRI: for spinal cord, disc and ligament injury, and when there are neurological symptoms
• CT angiography: if the vertebral arteries may be injured
• X-rays: for follow-up

Treatment

Stable fractures

• a rigid cervical collar for about 6 to 12 weeks
• pain relief
• follow-up X-rays to confirm healing

Unstable fractures

• Halo vest: a ring fixed to the skull and attached to a vest, holding the neck rigidly while bones heal (used less often now, especially in older adults)
• Surgery: spinal fusion with screws, rods or plates through the front or back of the neck; decompression if the spinal cord is compressed
• Traction to realign dislocations in some cases

Spinal cord injury care

Intensive care support for breathing and blood pressure, early surgery when indicated, and specialist rehabilitation. See spinal cord injury for more.

Risk factors

• age over 65 and osteoporosis
• ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis, which stiffen the spine and make it fracture more easily, often in unstable patterns
• rheumatoid arthritis affecting the upper neck
• high-risk activities: diving, contact sports, motorcycling, horseback riding

Complications

• spinal cord injury with paralysis (quadriplegia or partial weakness)
• breathing failure
• vertebral artery dissection and stroke
• chronic neck pain and stiffness
• non-union of the fracture, especially odontoid fractures in older adults
• pressure sores, pneumonia and blood clots during immobilization

Recovery and outlook

People with stable fractures and no nerve injury usually heal in 6 to 12 weeks and return to most activities within a few months, followed by physical therapy to restore movement and strength. Outcomes after spinal cord injury depend on the level and completeness of the injury.

Prevention

• Always wear a seat belt.
• Never dive head-first into shallow or unfamiliar water; enter feet first.
• Use correct technique and protective equipment in contact sports.
• Reduce fall risk in older adults with home safety changes, exercise and vision checks.
• Treat osteoporosis.

Frequently asked questions

What are the signs of a broken neck?

Signs include severe neck pain after an injury, tenderness at the back of the neck, stiffness and pain spreading to the shoulders. Numbness, tingling, weakness, loss of bladder control or trouble breathing suggest spinal cord injury and need emergency care.

Can you walk with a broken neck?

Yes, some people with stable neck fractures can walk and move their arms normally. That does not mean the injury is minor. Unstable fractures can shift and damage the spinal cord, so anyone with neck pain after trauma should be kept still and assessed.

How long does a broken neck take to heal?

Most cervical fractures heal in 6 to 12 weeks with a collar, halo or surgery. Full recovery, including regaining movement and strength with physical therapy, often takes 3 to 6 months or longer. Recovery after spinal cord injury can take much longer.

Can a broken neck cause paralysis?

Yes. If the fracture damages the spinal cord, it can cause weakness or paralysis of the arms, legs and trunk, and affect breathing. Many neck fractures, however, do not injure the cord, especially when handled carefully after the injury.

Why are older adults at risk of neck fractures from falls?

Aging bones are weaker from osteoporosis, and degenerative changes stiffen the neck. A simple fall onto the face or head can fracture the upper neck, especially C2. Older adults with neck pain after any fall should be assessed.