Thirty victims of blunt cervical trauma, who did not survive (acute death group); were studied at autopsy as were 11 patients who survived trauma for more than 1 month and ten controls without any known cervical trauma. All specimens were sagitally sectioned in 2-mm slices and carefully examined for injuries to the lateral parts of the atianto-axial joints. In the acute death group, five cases showed a rupture of the joint capsule, three of these with a massive hemarthrosis. In 17 cases there was bruising around the second cervical spinal nerve. Bruising of the intra-articular synovial fold was present in 15 cases, the posterior synovial fold being most commonly affected. There were five intra-articular fractures of the lateral masses, in three cases combined with a dens fracture. In two cases a bone fragment from the fracture compressed and obliterated the lumen of the vertebral artery. The findings are discussed in relation to pain after cervical trauma.