Long-standing ankylosing spondylitis may predispose a patient to serious cervical injury in the setting of minor trauma. Early diagnosis is essential to a favorable outcome. We report a 75-year-old man whose relatively minor trauma in the setting of AS resulted in a cervical fracture and callus formation, which masqueraded as a tumor. The patient developed neck pain, bilateral hypoglossal nerve palsy with dysarthria, and dysphagia that ultimately resulted in his death. This case illustrates progressive neurologic signs of gradual disarticulation of the skull from the cervical spine. The situation is considered of importance because it emphasizes the need for early recognition and possible intervention in the presence of hypoglossal symptoms. The specific combination of long-standing ankylosing spondylitis and minor trauma is one setting in which a clinician must be alerted. Early consideration of neck immobilization is emphasized.