The disease processes diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, and ossification of the posterior longitudinal ligament are similar in pathology and can lead to unexpected but grossly unstable fractures that may not be diagnosed until neurologic change occurs in cases of trivial trauma. A retrospective study of 29 patients with cervical spinal fractures and diffuse idiopathic skeletal hyperostosis-like pathologies was done. Twenty patients with an average age of 62 years were treated surgically (six neurologically complete, five incomplete, nine intact). Three patients with an average age of 70 years died postoperatively (one complete, two incomplete). Nine patients with an average age of 65 years were treated conservatively (five neurologically complete, two incomplete, two intact). All patients with intact neurologic function survived. It is suggested, therefore, that all elderly patients with diffuse idiopathic skeletal hyperostosis-like pathology, history of trivial trauma, and complaint of neck pain be examined carefully for fractures, because mortality rates increase sharply in patients with decreased neurologic function.