The most common type of injury of the cervical spine is the fracture-dislocation. Pure compression fractures are less frequent, and in many of these cases there is a complete separation of the parts of the vertebral body in the coronal plane, with division into an anterior and posterior segment. A condition much more unusual, and so far reported mainly in the cervical spine, is a vertical fracture of the body in the sagittal plane, splitting it into almost equal right and left halves, with or without compression or other concomitant fractures. It is this latter type of injury, vertical fracture of a vertebral body in the sagittal plane of the cervical spine (hereafter called vertical fracture), which will be considered in this presentation. The demonstration of a vertical radiolucent area in the region of the body of a cervical vertebra should arouse suspicion of this type of fracture. On the routine anteroposterior film, the differentiation between spina bifida occulta and fracture must be considered. The presence of the air density in the trachea is an additional confusing element. With body-section studies of the spine, the diagnosis of vertical fracture may be made with certainty. In our experience, with a single exception, a vertical fracture was seen only in combination with subluxation or other fractures of the cervical spine. The presence of a vertical fracture lends support to the suspicion of a slight subluxation or compression fracture in the equivocal case. Further, demonstration of the vertical fracture will present conclusive evidence of severe trauma to that part and may be a clue to the modus operandi of both an associated paraplegia and the fracture. Literature A review of standard textbooks in radiology and orthopedics failed to reveal any comment on vertical fractures of the vertebral bodies. Ellis (4) in his presidential address before the British Orthopedic Society in 1946 mentioned one such case occurring in a series of some 34 injuries of the cervical vertebrae and noted that there was no evidence of neurological involvement in his patient. Blumensaat (2) reports 2 cases, 1 involving C-5 and the other C-5 and C-6. Fractures of the laminae were also noted in both of these patients. Quadriplegia was present in one, and paraplegia in the other, with partial paralysis of the lower extremities. According to Blumensaat, Hoffa referred to fractures of this type in 1891. Incidence The incidence of vertical fractures is unknown. Over a five-year period in our hospital, 17 instances were recognized among 80 cases of cervical spine injury, in 48 of which there was quadriplegia. (Our institution is a paraplegic center.) Since most of the films were made at the bedside and their quality was uneven, it is probable that some such fractures were not detected. Summary of Findings in Seventeen Cases of Vertical Fracture of the Cervical Spine A. All were quadriplegic. B. Seven cases caused by automobile accidents.