Spine injury is one of the critical injuries due to vehicular accidents as injuries to the spine often cause morbidity and sometimes death especially if at upper cervical spine. This study aims to determine and compare the patterns of spinal injury in passenger car occupants, motorcyclists and pedestrians involved in road accidents. The study was undertaken on 670 victims of road traffic accidents who died due to all types of injuries and who were autopsied at Kuala Lumpur Hospital, Malaysia over a period of 4 years between January 2006 and December 2009. Of the 670 motor vehicle occupant fatalities included in the study, 176 (26.3%) cases presented with spine injuries. Most of the victims were motorcyclists (N=102, 62.2%) followed by passenger car occupants (N=43, 26.2%) and pedestrians (N=19, 11.6%). Of spinal injuries, the cervical region is the most common in all road accident victims. A higher proportion of MAIS 4 – 6 spine injuries were found for passenger car occupants compared to motorcyclists and pedestrians. Although 164 road accident victims presented with spine injuries, only 9 were attributed as the primary cause of death. Taking into account spine injuries contributing to fatal outcome, there were altogether 8.4% (56 out of 670) victims. The fatalities due to the spine injury are indeed very low and the occurrences of high severity spine injuries are usually concomitant with high severity injury in other body regions. The high severity of head and thorax injuries concomitant with spine injuries suggested that improved protection against injuries of these vital body regions could reduce spine injury severity as well.