Two patients sustained acute anterior spinal cord injury associated with a posteriorly displaced bone fragment and herniated cervical disc. Postmortem examination of both spinal cords showed extensive destruction of the cord at the site of injury with sparing of the posterior portion of the dorsal columns; the anterior spinal artery was patent. We conclude that posttraumatic anterior spinal cord syndrome can be caused by damage to the anterior part of the cord without involvement of the anterior spinal artery.