The unique anatomy and flexibility of the cervical spine predispose it to a risk 
of injury. Trauma to the cervical spine encompasses a wide range of injuries 
from minor muscular strains to life-threatening fracture-dislocations associated 
with spinal cord lesions. Initial assessment and management should follow the 
Advanced Trauma Life Support (ATLS) protocols with adequate protection of the 
cervical spine through triple immobilisation to prevent any unnecessary 
movement, which can make the patient susceptible to further neurological 
injuries. Although the presence of cervical spine injury is very often overt, 
reliance on clinical examination alone is sometimes not sufficient and 
potentially requires further imaging. Clinical decision rules such as the 
Canadian C-Spine Rule are frequently used to risk-stratify patients needing 
radiography. The level of cervical spine instability and knowledge of their 
unique classification systems is of paramount importance and assists in the 
decision-making process to guide definitive management. In this review, we also 
propose an algorithm to aid the initial management of a patient with suspected 
cervical spine injury in the emergency department.