Mechanical airway obstruction secondary to prevertebral hematoma following cervical spine injury is a life-threatening emergency. We present eight cases of mechanical airway obstruction from prevertebral hematomas in patients with cervical spine injury. They are combined with 13 previously reported cases to produce a study population of 21 patients. Although it is a rare complication of cervical spine injury, swelling significant enough to cause airway obstruction should be anticipated in all patients, regardless of age, severity of trauma, or lack of symptoms. To date, this phenomenon has not been reported in injuries below C6. Additionally, because symptoms may take hours to develop, initial cervical radiographs may not show evidence of retropharyngeal swelling and impending airway obstruction.