Fractures of the cervical spine in ankylosing spondylitis are rare. The rate of neurological complications is increased compared to fractures of the normal spine. Concerning its mechanical characteristics the ankylosing spine is similar to a long bone. Because of the deformity and the stiffness of the spine conventional orthoses do not provide enough stability and individualized techniques are necessary to perform safe rescue and transport. Because of severe instability an operation is indicated in most cases. The most stable fixation is the combined ventral and dorsal fusion. The dorsal approach is associated with an increased rate of complications, so we favour primary ventral fusion with long interlocking plates. This can be done even in difficult anatomic situations. If the screws can be tightened well, additional dorsal fusion is not necessary.