The management of cervical fractures in ankylosing spondylitis patients is controversial. In the present article, a literature review is conducted, and the author's experience with four consecutive cases, operated on using a combined approach, is reported. One patient was operated on using the combined approach after developing progressive deformity in a halo fixator, one patient after early redislocation of an anterior monosegmental fixation, and two patients were operated on primarily using the combined approach. All four patients achieved good alignment and immediate stability and no dislocation or deformity was observed during the mean observation period of 11 months.