The National Football Head and Neck Injury Registry documented 1129 injuries since 1971 that involved hospitalization for more than 72 h, surgical intervention, fracture-dislocation, permanent paralysis or death. Of this group of injuries, 550 were fracture-dislocations of the cervical spine, of which 176 were associated with permanent quadriplegia. It appears that during the last 2 decades, there was a decrease in the incidence of direct fatalities, head injuries associated with intracranial hemorrhage and injuries associated with death. Cervical spine injuries with fracture-dislocation and with permanent quadriplegia increased. These observations are the result of the development of a protective helmet-face mask system that effectively protected the head, and by so doing allowed it to be used as a battering ram in tackling and blocking techniques, placing the cervical spine at risk of injury.