Subaxial cervical spine fractures and dislocations encompass a broad spectrum of acute traumatic injuries. Adequate decompression of the neural elements and the restoration of sufficient spinal stability to allow early mobilization and rehabilitation remain basic treatment tenets. Although nonsurgical treatment can be employed successfully, surgical treatment of these injuries achieves these goals more consistently and more quickly, especially in higher grades of injury. Both anterior and posterior surgical approaches have been reported as effective. Neither approach is necessarily superior to the other as long as the goals of treatment can be accomplished. Treatment must be individualized on the basis of the specific characteristics of each particular injury. Factors to be considered include neurologic status, the degree and type of bony and/or ligamentous disruption, and the degree and cause of spinal cord compression. The treatment of patients with AS who sustain traumatic subaxial cervical spinal fractures is challenging and has a comparatively high associated morbidity and mortality, regardless of the treatment offered or the surgical approach used. © 2013 by the Congress of Neurological Surgeons.