Objective: To investigate the anterior cervical decompression combined with flexion traction reduction and fusion for the treatment of fracture and dislocation of the lower cervical spine with facet locking. METHODS: From January 2015 to January 2019, 45 patients with lower cervical spine fracture-dislocation accompanied with facet locking who were treated by the anterior approach were retrospectively analyzed. After preoperative X ray, CT and MRI data were obtained, the sagittal Cobb angle was recorded. All patients were evaluated by Neck Disability Index (NDI) score and the Japanese Orthopedic Association (JOA) score. All patients underwent decompression, reduction and arthrodesis by anterior means. Cobb angle was recorded during regular follow-up. The clinical efficacy was evaluated using Odom’s criteria, NDI and JOA scoring system. RESULTS: All patients were successfully reduced intraoperatively and effectively fused during follow-up. No loss of sagittal Cobb angle was observed during the follow-up. The Cobb angle, NDI and JOA scores were significantly changed from preoperative values of 13.4±7.5°，31.9±8.2 and 4.3±5.1 to last follow-up values of 0.3±3.2°，22±14.5 and 10.8±6.3 respectively. Finally, 17 patients had good to excellent clinical outcomes, 5 patients had good results, 10 patients had medium results and 13 patients had poor results. A total of 26 of the original 45 patients showed varying degrees of neurological function recovery. CONCLUSIONS: For lower cervical fracture-dislocation accompanied with facet locking, satisfactory clinical outcomes can be obtained by choosing the anterior surgical approach.