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Cervical C1-C2 fusion

C1/2 fixation - side view


Fusion of the first two vertebrae of the spine (atlas and axis or C1 and C2). There are different techniques. The first technique was published in the …. and used a bone graft taken from the hiwhich was placed between the posterior arch of C1 and the spinous process of C2. This was secured in place with a wire or cable. The disadvantage is that the spinal cord cannot be decompressed at the same time because the piece of bone which is usually removed to decompress the cord is necessary to keep the graft in place. However, for many years this was the treatment of choice (and only one available). Nowadays, this technique has been largely replaced.More recent techniques are transarticular screw fixation and direct C1 lateral mass –C2 pedicle screw fixation (so-called Harms fusion). These techniques allow direct fusion if C1 and C2 and decompression can be done at the same time. These are, however, demanding techniques and the National Institute for Health and Care Excellence in the U.K. (NICE) has issued guidelines for this.


C1/2 fixation, Atlanto-axial subluxation / instability (i.e. rheumatoid arthritis), C1/C2 instability following fractures, tumours or infection (TB)


Infection, bleeding, CSF leak, neurological damage including paralysis, stroke, no improvement of symptoms, death in cases of cervical cord injuries or injury of the vertebral arteries which supply the brain stem, failure of inserted metal work requiring further surgery. The very serious risks are small in experienced hands but nevertheless real.

Hospital stay

2-3 days after operation in majority of cases.


Always general anaesthesia


The neck might feel sore for a short time. A collar is not routinely necessary if x-rays after the operation are satisfactory.

Commonly asked questions

How much will the operation effect my neck movements?

It is important to know that fusing C1 and C2 will lead to a significant reduction in the ability to rotate the head and look to the sides. This is because most of the rotation movement in the neck is between these two vertebrae. Bending the neck forwards and backwards is, however, little effected because this movement largely happens between the skull and C1.

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