It is well established that there is an increased frequency of atlanto-axial instability in Down's syndrome. In two out of the 27 patients with Down's syndrome who were examined, there was an atlanto-axial dislocation, but without any corresponding neurological symptoms. However, scrutiny of the X-rays revealed many cases with marked degenerative changes, particularly in the upper part of the cervical spine. The degenerative changes in Down's syndrome patients were compared with those in age- and sex-matched patients examined because of cervicalgia. Patients examined because of acute neck traumatas constituted a second control group. The results indicate that there is a significant increase in degenerative changes in the upper part of the cervical spine in Down's syndrome.