Abstract: Objective To observe the differences in radiological signs of cervical spine CT and X-ray in patients with upper cervical spine injury, and provide guidance for prognosis analysis. Methods The patients with atlas injury in our hospital from June, 2014 to January, 2015 were selected. X-ray and CT were performed in all patients before and after the treatment. To compare the difference in the morphologic changes of the injured cervical spine between X-ray and CT combined with the prognosis of patients. Results The accuracy rate of X-ray for fracture displacement less than 3 mm, angulation deformity, hyperextension injuries and vertical compression injury of violence was 26.67%, 50.67% and 16.00%, respectively, which was lower than 42.67%, 66.67%, 42.67% of CT(P<0.05); The correct diagnostic rate of spiral CT three-dimensional imaging technology was significantly higher than X-ray(100.00% vs. 80.00%, P<0.05); The poor prognosis of patients was correlated with the misdiagnosis or missed diagnosis(P<0.05). Conclusion The misdiagnosis and missed diagnosis can occurred by X-ray examination for upper cervical spine injury. For the patients with fracture displacement less than 3 mm, angulation deformity, hyperextension injuries and vertical compression injury of violence, spiral CT three-dimensional imaging after X-ray can improve the diagnosis accuracy, and avoid the poor prognosis.