The goals of this study were to document the incidence of all injuries to the cervical spine at four Western New York high schools over two consecutive football seasons, and to compare the regional incidence to other reports. We also sought to identify the athletes at greatest risk of injury as determined by preseason questionnaire, medical history, and physical examination. Seventy-four high school football players entered the study prior to their junior season of play, and were followed prospectively for any reportable injury to the cervical spine. An overall 10.8% rate of injury occurred over the two-year study period; the highest rate was for defensive backs and linebackers making a tackle. Thirty-two percent of players had an abnormal history, examination, or both prior to the first season of play. The medical community has a responsibility to educate the public concerning cervical spine injuries in high school football players.