For the physician treating an injured patient, it is important to recognize fracture of the cervical spine without neck pain. Films of the cervical spine in patients with head or facial trauma, or patients who are unconscious, inebriated, or have multiple injuries, should be routine and are best obtained by portable technic in the emergency room before procedures requiring or resulting in cervical manipulation. The cost of cervical spine injury may be great for the patient, society, and the physician who fails to recognize it.