Which condition should be ruled out based on signs such as refusing to move the neck, UMN signs, intermittent LOC, weak and painful neck muscles, and marked muscle spasm?

• A. Dislocation
• B. Fracture
• C. Cervical sprain
• D. Disc herniation

Answer: (B)

When there are signs suggesting cervical spine injury with potential spinal cord involvement, the priority is to exclude a fracture. A fracture can be unstable and allow the vertebrae to shift with even gentle movement, risking acute or progressive spinal cord injury. The combination of refusing to move the neck, upper motor neuron signs, intermittent loss of consciousness, and marked neck muscle spasm points to possible structural instability rather than a simple soft-tissue strain. Because a fracture changes management dramatically (immobilization and urgent imaging before any examination or manipulation), it must be ruled out first. Cervical sprain or disc herniation can cause neck pain and spasms, but they do not inherently imply the same level of acute spinal instability or risk of cord injury as a fracture. Dislocation is also dangerous, but the red flags here most strongly support fracture as the immediate concern to exclude.