Abstract: Objective To explore the clinical effect of anterior decompression reduction and internal fixation in the treatment of fracture and dislocation of lower cervical spine (FDLCS) combined with spinal cord injury (SCI). Methods A total of 80 patients with FDLCS combined with SCI treated from September 2018 to August 2022 were randomly divided into the anterior approach group (40 cases) and the posterior approach group (40 cases) by drawing lots. Operation, follow-up and imaging indexes were compared between the two groups. Results The patients in both groups successfully completed the operation. The operative time, incision length, intraoperative fluoroscopy times, intraoperative blood loss, postoperative drainage volume and hospital stay in the anterior approach group were better than those in the posterior approach group (P < 0.05), and there was no significant difference in early complications between the two groups (P > 0.05). The two groups were followed up for (16.5±3.0) months. As time went on, VAS score decreased, JOA score increased, and ASIA grade improved (P < 0.05); VAS score and JOA score in the anterior approach group were significantly better than those in the posterior approach group at 3 months after surgery (P < 0.05), and there were no significant differences in JOA score and ASIA grade between the two groups at the last follow-up (P > 0.05). The Cobb Angle and the anterior sliding distance of intervertebral space decreased after operation in both groups (P < 0.05), while the height of intervertebral space increased (P < 0.05). The Cobb Angle and the anterior vertebral space slip distance of the anterior approach group were lower than those in the posterior approach group at 7 days after surgery (P < 0.05), and there were no significant differences in Cobb Angle and vertebral space height between the two groups at the last follow-up (P > 0.05). Conclusions The treatment of FDLCS combined with SCI by anterior decompression reduction and internal fixation has the characteristics of less trauma and rapid postoperative recovery, which can promote fracture dislocation and improve spinal cord nerve function. Key words: Fracture and dislocation of lower cervical spine; Spinal cord injury; Anterior surgery; Surgical approach;