Neck extension

Neck extension usually aggravates pain when cervical disc disease is present (a minority of patients instead exhibit pain with cervical flexion).

Neck extension is likely to be relatively safe in injuries that are stable in flexion and extension, such as odontoid fracture type II and cervical spine fractures between C5 and C7. Head rotation is likely to be relatively safe in fractures below C4, as well as cervical vertebral body fractures, and laminar fractures without disc disruption. Early dialogue with the neurosurgical team remains a central tenet of the safe management of patients with combined maxillofacial and cervical spine injury ¹⁾