Cervical spineMinimally invasive surgery

C1–C2 atlantoaxial fusion

C1–C2 atlantoaxial fusion is considered for patients with high neck and occipital pain, instability or difficulty keeping the head steady, often with tingling, weakness or gait issues from cord compression at the C1–C2 joint. Using screws and rods to fix the atlas and axis, plus bone graft, it aims to stabilise the upper cervical spine and protect the cord and roots. Indication is personalised based on symptoms, neurological exam and imaging when instability or disabling pain do not respond to conservative measures.

Spine neurosurgeon in Alicante and Benidorm

More than 20 years of experience in Neurosurgery (since 2003)

Vithas Medimar Hospital Alicante and Hospital Clínica Benidorm

Medical illustration of C1–C2 atlantoaxial fusion to stabilize the upper cervical spine.

What is C1–C2 Atlantoaxial Fusion?

It is an upper cervical fusion linking the atlas (C1) and axis (C2) with screws, rods and bone graft to eliminate unstable motion that can cause pain or compress the cord and roots. It is performed through a posterior approach to stabilise the atlantoaxial joint.

Symptoms and signs to consider

In C1–C2 instability, watch for:

High cervical pain and occipital headache worsened by movement

Feeling of instability or difficulty holding the head steady

Gait disturbance, stiffness or unsteadiness when walking

Tingling, numbness or weakness in the upper limbs

Neurological red flags: sudden or progressive loss of strength, falls, bowel or bladder changes

When is this surgery indicated?

Atlantoaxial instability documented on MRI/CT or dynamic X-rays

Severe upper neck or occipital pain unresponsive to conservative treatment

Neurological compression with tingling, weakness or gait disturbance

Risk of neurological progression due to abnormal motion at C1–C2

Step-by-step overview of the procedure

1.Preoperative evaluation and planning

Neurological exam and detailed review of MRI, CT and X-rays (including dynamic studies) confirm instability and guide screw planning. Goals, benefits and risks are explained, medication (anticoagulants/antiplatelets) is adjusted and fasting instructions are provided before admission.

2.Screw and rod placement and fusion preparation

Under general anaesthesia via a posterior approach, the patient is positioned prone with the head secured. C1 and C2 are exposed, screws are placed in C1 lateral mass and in C2 (pedicle or pars) as anatomy allows, guided by landmarks and imaging. Rods are connected, bone graft is placed to promote fusion and stability is checked before closing the wound.

3.Immediate postoperative care and early mobilisation

After surgery, vitals, pain and neurological status are monitored in recovery and on the ward. Upper neck pain is expected and managed with analgesia. Mobilisation usually starts gradually (sitting, walking with assistance), and a collar may be used depending on the team’s criteria. Typical hospital stay is 48–72 hours if recovery is favourable.

Recovery and daily life after C1–C2 fusion

Recovery is gradual. Early weeks often bring muscle pain and stiffness, improving with analgesia and physiotherapy. Effort and abrupt neck movements should be avoided. Return to office work is usually considered between 3 and 4 weeks; physical jobs may need 8–12 weeks or more. Follow rehab guidance and watch for red flags such as fever, increased pain, weakness or sensory changes.

Risks and possible complications

General risks: anaesthesia, wound infection, bleeding, haematoma, venous thrombosis. Specific risks: spinal cord or root injury with neurological worsening, screw malposition requiring revision, pseudoarthrosis, residual neck pain, loss of cervical rotational mobility and, rarely, vascular injury. These risks are weighed against the benefit of stabilising C1–C2 in each case.

Frequently asked questions

It usually lasts about 1 to 2 hours depending on anatomy and need for decompression. Add time for operating room preparation and recovery.

There is no pain during surgery because it is under general anaesthesia. Afterward, upper neck pain is common and managed with analgesics, typically improving over days and weeks as inflammation settles.

For office jobs, return is often considered between 3 and 4 weeks if pain and mobility allow. Physical jobs with lifting or fall risk may need 8–12 weeks or more, adjusted in follow-up.

Gentle walking starts early and progresses gradually. Impact or contact sports are usually delayed several weeks; typically from 8–12 weeks depending on recovery and surgeon/physio guidance.

Recurrence of the same instability at the fused level is unlikely. Other levels may degenerate over time. If preoperative neurological damage was significant, recovery may be partial.

C1–C2 fusion is more focal and preserves more motion than occipitocervical fusion, which includes the skull. Compared with lower cervical fusions, it targets the atlantoaxial joint for high cervical instability or compression.

Not always. It is indicated when documented instability, disabling pain or neurological risk persist despite conservative care. The decision is individual after weighing risks and benefits with the specialist.

Do these symptoms sound familiar?

If you recognise yourself in some of these symptoms and your pain is starting to limit your daily life, we can review your case in a personalised consultation. Dr. Ben Ghezala will assess your clinical history and imaging studies to help you decide the best treatment option for you.

Request a consultation with Dr. Ben Ghezala