Objective: To evaluate different means in the diagnosis of cervical hyperextension injury with surgical treatment consideration. Methods: Fifty-three cases of cervical hyperextension injury were retrospectively analysed, and their injury history, clinical manifestation, X-ray films, MRI and treatment were studied. Results: Thirty-four cases were detected by means of X-ray films, accounting for 64.15%; the main pathological changes of MRI were rupture of anterior longitudinal ligament, partial or total horizontal tear of disc, disc herniation, compression and edema of spinal cord. All cases were detected with variable MRI abnormal changes, 7 cases of vertebral artery occlusion were found. The result of surgical treatment was superior to conservative treatment. Conclusion: MRI is superior to other diagnosis methods on injury detection, description of injury mechanism and injury severity, and it has already become the most valuable choice for diagnosis. The consideration of operation indication and surgical approach should be based on decompression and stability.