Objective To investigate the treatment of combined injuries tu the upper and lower cervical vertebrae. Methods Nine consecutive patients (4 females and 5 males) with combined injuries to the upper and lower cervical vertebrae underwent different treatments in our department from March 2000 to March 2008. Their mean age was 39.3 years, ranging from 18 to 67 years. Six cases had neurological deficits. Two cases received conservative management (4 weeks of cervical traction followed by Dick splint or plaster fixation). Seven cases received different kinds of operation (upper cervical fixation in one case, lower cervical fixation in 3 cases and upper plus lower cervical fixation in the other 3 cases) followed by postoperative immobilization with Dick splint or neck support. Results One case died of respiratory infection 6 months after operation. The other 8 cases were followed up from 6 to 32 moths, with an average of 19 months.There were no neurological or vascular complications during surgery or traction. There were no cases of implant failure. Neurological symptoms were improved significantly in 5 cases. At the final follow-up, all patients demonstrated evidence of solid fusion on radiographs. Conclusions The stability of the upper and lower cervical spine and the severity of nerve injury determine whether conservative treatment or open surgery should be indicated for combined injuries to the upper and lower cervical vertebrae. In surgery, the lower cervical vertebra should be stabilized first of all. Key words: Cervical vertebrae; Spinal injuries; Fracture fixation