Cervical spine changed by Bechterew's disease is severely endangered with any 
increased load. Even decent trauma is enough to produce a fracture with 
affection of spinal cord. Because of little knowledge in these special items, 
late diagnosis of overlooked injury is not rare, especially in two-level 
injuries. Neurolesions following secondary fracture dislocations may occur 
("fatal pause"). From january 1990 to february 2000 12 patients underwent 
surgery (dorsoventral stabilisation, ventral stabilisation, laminectomy). 
Diagnostic procedures, levels of injury, pre- and postoperative neurostatus 
(following Frankel's score), operative technique, typical complications and 
follow-up (Ø 17.8 months) were analyzed and compared with the literature. 11 
patients showed preoperative neurodeficits. They were better in five cases and 
disappeared at all in another five cases after surgery (83% positive 
neurological outcome). There was no increase of neurology failure. Two patients 
died (ARDS and cerebral ischemia with destruction of vertebral arteries). One 
patient had to be reoperated because of implant dislocation. MRI is obvious in 
diagnostic for these lesions. There is also an absolute need for total (both 
clinical and radiological) examination of the whole spinal column, because there 
is often injury of more than one level (three times in our study). Therapy 
should be operative (dorsoventral stabilisation, in certain cases only anterior 
procedure or laminectomy). Late diagnosis and therapy with secondary worsening 
after fracture dislocation is not rare because of "overlooked injury". There 
were four patients, that would not have suffered cervical spine fracture 
(minimal injury force) without Bechterew's changes. There is often pulmonary 
failure through limitation of thoracic movement and cerebral ischemia following 
rupture of vertebral arteries as typical complications. Mortality (2 cases; 16%) 
in our collective is less than literature's medium rates (35-57%).