Geriatric spinal injuries are different from those in the younger population in various aspects and due to different reasons. Cervical spine injuries account for up to 78% of all spinal injuries in elderly. Within this, odontoid fractures and hyperextension injuries account for a majority of these injuries. Fall is the most common cause of spinal injury in elderly patients who are more than 75 years old. Even minor trauma can cause injury. There is a high incidence of missed diagnosis and hence suspected patients should be re-examined to rule out cervical spine injuries. There is a significantly higher complication and mortality (26%) rate. Primary aim of treatment is to keep the patient mobile in order to promote maximum respiratory function. Bony union is not always necessary. A rigid collar provides adequate immobilization. Most patients can be treated conservatively. Surgical treatment is generally required only in dislocations and Type III hangman fracture.