The patient who arrives at the emergency department (ED) with real or potential cervical spine injuries is a common problem. Often, this patient arrives in the busy ED immobilized, uncomfortable, and frightened. In addition, the patient can have other injuries or conditions, that make the history and physical examination unreliable. The emergency physician (EP) must be prepared to manage this patient with potential injuries to the neck and cervical spine efficiently and effectively. To accomplish this task, the EP must adhere to the basic principles of trauma management and protect the cervical spine to prevent additional neurologic injury. The EP must know the complex anatomy of the cervical spine and understand the mechanism and types of neck and cervical spine injuries. The EP must be able to recognize and manage associated soft tissue, vascular, and neurologic injuries. Last, the EP must have an understanding of immobilization techniques, the utility and limitations of available imaging modalities, and the management of specific patient populations at risk for neck and cervical spine injuries (e.g., the athlete).