Subaxial cervical fractures are one of the most devastating injuries managementshould start at the field by safe transportation and medical treatment surgicalmanagement is done either anterior, posterior or both and this is done todecompress the spinal cord and fixation of vertebral column. The surgicalapproach is determined according to the direction of the compressing element.The study was upon 20 patients at casualty department at Cairo UniversityHospitals. We recommend the use of combined approach in case of fracturesthat cause 3 columns disruption.