The presentation, diagnostic evaluation, treatment, and 5 years follow-up of a 12-year-old Arabian-Saddlebred cross gelding with neck pain and stiffness, attributable to a fracture of the third cervical vertebrae (C3), is described. Initial cervical spinal radiographs revealed a concave defect in the ventral aspect of the cranial end plate of C3. However, both this finding and ultrasonographic imaging of the area were inconclusive for a fracture. Nuclear scintigraphy revealed that the lesion was metabolically active, prompting computed tomographic imaging that revealed a fracture of C3. Sequential radiographs documented progressive fusion of C2-C3 and no neurological deficits developed over the 5 years after the injury. Cervical vertebral injuries in horses can lead to various clinical signs including ataxia, weakness, and neck stiffness or pain. Diagnosis with cervical radiographs alone can be challenging and, in some cases as the horse in this report, multiple imaging modalities may be required to establish a definitive diagnosis. Horses without neurological signs may recover successfully with conservative medical management, which was performed in this case.