The authors reviewed the medical records of 53 patients with a lower cervical spine injury who were treated by anterior decompression, bone grafting, and instrumentation using an anterior cervical spine plate and screws. The average age of the patients was 36 years and the mean followup was 58 months. Twenty-six patients predominantly had anterior lesions and 27 patients predominantly had posterior lesions. Thirteen patients were neurologically intact. Fusion was achieved in all patients at an average of 3.4 months postoperatively. Radiographic followup detected 15% of hardware malposition. There were no pseudarthrosis, dysphagia, or neurologic complications. Incomplete spinal cord lesions improved on average one Frankel grade after surgery. Anterior decompression and stabilization is a safe and effective procedure for the treatment of acute lower cervical spine injuries and permits immediate postoperative mobilization of the patient.