Cervical spine mobility is central to the conventional safe management of the airway. Acquired causes are mainly degenerative diseases (osteoarthritis, degenerative disc disease), inflammatory processes (rheumatoid arthritis, ankylosing spondylitis), trauma, and prior surgical fusion. This chapter presents a case study of a 68-year-old male with severe ankylosing spondylitis who sustained a fracture through the C6 vertebral body following a fall. The patient was positioned in the prone position with care taken to avoid cervical spine extension and to preserve the alignment of the cervico-thoracic spine, to the extent that was possible given the underlying deformity. The blood pressure was maintained at preinduction values at all times. The patient presented in this case demonstrated several of the features that predict difficulty in airway management. Awake flexible fiberoptic intubation is considered to be the gold standard in this challenging patient group.