To the Editor.— Adequate radiological visualization of the lower cervical vertebrae in the lateral projection frequently requires that cephalad traction be applied to the patient's head while the shoulders are pulled caudally by traction applied directly to the upper extremities. However, in patients with possible neck injuries, this maneuver should not be used unless the lateral initial roentgenogram is inadequate and there is a low degree of suspicion (ie, the patient is awake without neck pain) because certain types of injuries, notably a bilateral interfacetal dislocation and a flexion teardrop fracture, are associated with complete ligamentous disruption. Such distraction may lead to, or aggravate, injury to the spinal cord or vertebral arteries. Report of a Case.— A 34-year-old man was injured in a motor vehicle accident, which caused a brief loss of consciousness and respiratory problems that required intubation. He rapidly recovered a normal level of consciousness, and the only