Estimates of the incidence of injury to the cervical spine among patients suffering blunt trauma to the head vary widely, and have been reported to be as high as 20%. Since strict observation of cervical spine precautions may delay attempts to gain control of the airway in a patient with an intracranial injury, the risk involved needs more exact definition. In an attempt to quantify this risk, the records of 1,272 consecutive patients with blunt injuries admitted to a Level I regional trauma center were reviewed. Patients with serious craniocerebral injury were at no greater risk for injury to the cervical spine than patients without trauma to the head (1.8% vs. 3.5%, p = NS by Chi-square analysis). Although observance of cervical spine precautions is usually paramount, there may be times when this concern is superceded by the need to gain definitive airway control in a patient with injury to the brain.