Atlantoaxial Fixation


Atlantoaxial fixation is an advanced surgical technique where a very effective treatment for altantoaxial instability is performed. Altantoaxial fixation is performed to provide stability, prevent neurological deficits and correct deformity. This instability can occur in bone (the atlas, C1 and the axis, C2) as well as in ligaments too.

What is Atlantoaxial?

Atlantoaxialis a combination of two words atlanto means the atlas bone (C1) and the axis bone (C2) is basically a joint present in the upper part of the neck. The first, known as the atlas (C1) and second known as the axis (C2) cervical vertebrae of a spinal cord. It is also known as pivot joint which is very helpful in the movement of head and neck. This pivot joint is very complex in nature and consists of no fewer than four distinct joints. Flexion and extension of the neck involves an articulation in between C1 and C2. When the atlantoaxial instability occurs more often in between C1 and C2 then Atlantoaxial Fixation is required. Patient with Down’s syndrome is often treated with Atlantoaxial Fixation

Why Atlantoaxial Fixation is important?

Atlantoaxial fixation is an advanced surgical technique performed majorly on the patients with odontoideum, neoplasm, infection and degenerative connective tissue disorders such as rheumatoid arthritis, genetic conditions such as HOX-D3 and Down syndrome, and heritable connective tissue disorders. Statistics shows that 50% of the global population still suffering from Atlantoaxial instability. Different techniques and surgeries are being performed on daily basis on these patients. Out of these the spine world came with a latest advanced surgical technique called Atlantoaxial Fixation which helps in the deformity and to cure instability soon.

What conditions require for Atlantoaxial Fixation?

Atlantoaxial fixation is performed when there is a dislocation or instability in C1 and C2 vertebras occurs. This surgical technique helps in fixing C1 and C2 which is responsible for the neck movements flexibly. The symptoms are:


  • Sports trauma
  • Disc dislocation
  • Asymptomatic instability
  • Symptomatic instability
  • Patient with medical history of spinal cord or cervical vertebrae injury and degenerative changes in the cervical spine are the major reasons which lead to this surgery.

The Procedure

  • Certain tests are recommended by or surgeons before they start surgery:

    • Certain Blood tests
    • MRI (magnetic resonance imaging)
    • CT (Computed Tomography)
    • X-rays

    Fixation surgery is performed by a team of expert surgeons. Patient is subjected to position prone on neurosurgical operation table with the head in “U” position so as to prevent pressure points and eyes. A dose of general anaesthesia induced to the patient before surgery. Surgeons generally keep skull tongs after incision is made at pivot joints and after surgery tongs get removed and the incision is tightened for quick recovery. The fixation of C1 and C2 is performed by following methods:

    • Magerl/Screw technique: The Magerl is a computer assisted free hand technique. The Magerl technique can be summarized as the posterior atlantoaxial screw fixation technique. A cave like incision is made slight above C3 till anterior part of C1to reach C1 C2 is performed for the fixation. During this, screw is inserted two on right and two on left to the atlas and the axis in between C1 C2 to retain the mobility again.

    • Goel/Harm’s technique: Harm’s technique also referred as Goel technique, is performed in posterior atlantaxial stabilization. The Poly axial screw of selected length is passed usually without taping, which ensures safe hold of the screw. Depending on the CT scan reports the length of the screw varies, accordingly fixation of screw in C1 C2 is done.

    Hospital stay of up to 7 days or even more may be required. Recovery will depend on several factors:

Post Atlantoaxial Fixation Care

This fixation surgery is recommended to children having ADI greater than 5mm, and in adults when ADI is greater than 10 mm or any neurologic findings develop.

Post Atlantoaxial Fixation Care

  • Recovery after C1-C2 surgery takes time, which require precautions along with proper rest.
  • Experts suggest avoiding excessive movement of neck.
  • Close monitoring on children is done to avoid any signs of neurologic involvement for example sport activities like gymnastics, diving, pentathlon, butterfly stroke, diving starts in swimming, high jump, soccer.
  • Certain exercises should be avoided to get good health.
  • If everything goes well, patient can go home in about two to three days after the surgery.
  • Patient can return to regular activity after six to seven weeks.

Results of Atlantoaxial Fixation

After Atlantoaxial fixation surgery joint can easily move in any direction after sometime. Within one month after surgery, patient can resume all the major daily activities and feels far better than before. It helps the patients to get completely cured after long term illness and pain.

Benefits of Atlantoaxial Fixation

  • Best and obtainable surgical technique.
  • Quick recovery after this surgery.
  • Patient can get back to home after two to three days.
  • Patients get quick relief from long term neck illness.
  • Patient get discharged from most of the symptoms and no on-going damage to this crucial junction in between brain and spinal cord occurs.
  • After Atlantoaxial fixation surgery, patient can usually back to his normal activities within a month.

In neuro endoscopy, an endoscope is inserted through a small opening in the skull.

Why NICE ?

  • We are associated with the best hospitals globally having the emergency infrastructure, fully equipped with the latest technologies and techniques to overcome from every emergency condition.
  • Our team of doctors are highly experienced in ‘Emergency Patient Management’ and work together to save the patient.
  • Consultation from doctors through e-mail, phone, and video calling.
  • Rehabilitation programs are organized to assist complex surgery patients.
  • Complete support and assistance being given before and after treatment.
  • Cost of treatment is quite less as compared to other service providers.
  • We are always ready to offer our helping hand and our services are available 24/7.