Objectives. To compare the incidence of perioperative and early postoperative complications of surgical tracheostomy (ST) vs. ultrasound-guided percutaneous dilational tracheostomy (PDT) in patients with anterior cervical spine fixation (ACSF). Summary of Background Data. The patients with ACSF after acute spinal cord injury often require tracheostomy. Surgical tracheostomy is burdened with relatively high incidence of peristomal infections, and, recently, ultrasound-guided PDT is proposed in patients with ACSF. Methods. Sixteen adult patients who underwent tracheostomy after acute spinal cord injury and ACSF were analyzed. The patients were randomly assigned to two groups: eight patients (six males; age range, 24-59 years) who underwent ST and eight patients (seven males; age range, 19-47 years) who underwent ultrasound-guided PDT with dilatational forceps technique. The incidence of peri- and early postoperative complications was followed up, as well as the stoma infections and the duration of the procedure. Results. Not one patient from either group had any major perioperative complication of tracheostomy. In each group, there was one case of prolonged bleeding, which stopped spontaneously inside 24 hours. In two patients (25%) from the ST group, purulent infection of the stoma was verified during subsequent treatment at an intensive care unit. The average time of ST was 21 ± 7 minutes; the average time of ultrasound-guided PDT was 8 ± 6 minutes (P < 0.05). Conclusions. Our preliminary data demonstrate that ultrasound-guided PDT as regards to complications is at least equally safe as ST; at the same time, it is much quicker method, probably with less late infections of the stoma, which could be an important advantage in patients with ACSF.