C1-C2 Fusion

Advanced Cervical Spine Treatment by Dr. Ankit Daware – Consultant Spine Surgeon

The upper cervical spine—especially the junction between the C1 (Atlas) and C2 (Axis) vertebrae—is one of the most critical regions of the human body. It supports the head, enables rotation, and protects the brainstem and spinal cord. When this region becomes unstable due to injury, arthritis, congenital deformity, or disease, patients may experience severe neck pain, restricted mobility, and even life-threatening neurological complications.

For individuals in Nagpur and across Central India, Dr. Ankit Daware, a leading spine surgeon, provides specialized treatment options including C1–C2 Fusion Surgery. With advanced surgical techniques, high success rates, and precise diagnosis, Dr. Daware ensures safe and effective care for patients suffering from upper cervical instability.

Understanding the C1–C2 Region

The C1 vertebra (Atlas) supports the skull, while the C2 vertebra (Axis) enables rotation of the head. These two bones form a highly mobile joint responsible for nearly 50% of all head rotation. However, because this region is so flexible, it is also vulnerable to instability. Even minor disruptions in this area can compress the spinal cord, leading to pain, stiffness, and neurological symptoms.

What Is C1–C2 Instability?

C1–C2 instability occurs when the normal alignment between the atlas and axis is disrupted. This abnormal movement may occur due to trauma, degeneration, inflammation, or congenital abnormalities. When untreated, it poses serious risks including spinal cord compression, nerve damage, and progressive deformity.

Common Causes of C1–C2 Instability

Several conditions may lead to instability at the upper cervical segment. Some of the most common include:

1. Trauma or Injury

High-velocity injuries such as

Road traffic accidents
Sports injuries
Falls from height
can cause fractures, ligament tears, or misalignment.

2. Rheumatoid Arthritis (RA)

RA can weaken ligaments and joints, leading to progressive instability.

3. Congenital Disorders

Conditions such as:

Os odontoideum
Down syndrome
Skeletal dysplasias
may lead to lifelong cervical instability.

4. Degenerative Spine Disease

Wear and tear due to aging can cause ligament laxity and bone changes.

5. Infections or Tumors

Occasionally, infections like tuberculosis or tumors around the cervical spine may damage bone and soft tissue.

6. Inflammatory Disorders

Chronic inflammation weakens supporting structures, causing excessive motion at C1–C2.

Symptoms of C1–C2 Instability

Symptoms may vary depending on severity, but common signs include:

Severe upper neck pain
Headache at the base of the skull
Restricted head rotation
Clicking or grinding sensation
Tingling or numbness in arms
Weakness in limbs
Difficulty walking or balancing
Dizziness or vertigo
In severe cases, breathing or swallowing issues

Although symptoms may start mildly, instability can progress rapidly. Therefore, early evaluation by a spine specialist like Dr. Ankit Daware is essential.

When Is C1–C2 Fusion Needed?

C1–C2 fusion is recommended when instability threatens spinal cord safety or causes chronic pain that does not improve with conservative treatment.

Indications for Surgery:

Persistent neck pain despite physiotherapy or medications
Progressive neurological symptoms
Spinal cord compression on MRI
Unstable fractures
Atlantoaxial subluxation
Rheumatoid arthritis with instability
Tumor or infection-related instability
Congenital instability causing severe symptoms

Early surgical intervention prevents permanent neurological damage and restores spinal stability.

What Is C1–C2 Fusion?

C1–C2 Fusion, also known as Atlantoaxial Fusion, is a procedure performed to stabilize the joint between the atlas and axis. In this surgery, screws and rods or other implants are used to hold the two vertebrae in a fixed position until bones naturally fuse over time.

The goal is to:

Prevent abnormal motion
Protect the spinal cord
Reduce pain
Improve stability
Prevent deformity progression

Types of C1–C2 Fusion Techniques

Dr. Ankit Daware uses the most advanced and safe surgical methods based on each patient’s anatomy and condition.

1. Goel–Harms Technique

The most widely used modern technique, involving C1 lateral mass screws and C2 pedicle/pars screws connected with rods.
Benefits:

Strong fixation
High fusion rate
Safe for most patients

2. C1–C2 Transarticular Screw Fixation

Screws are placed across the C1–C2 joint.
Benefits:

Excellent biomechanical stability
Suitable for selected patients

3. Occipitocervical Fusion (If Needed)

If instability extends upward to the skull base, fusion may include the occiput (back of the skull).

4. Posterior Wiring Techniques

Less commonly used today, but beneficial in selected anatomical situations.

Pre-Surgery Evaluation by Dr. Ankit Daware

Before surgery, a detailed evaluation ensures precise diagnosis and safe surgical planning.

Diagnostic Tests Include:

MRI Scan: evaluates spinal cord compression
CT Scan: studies bone anatomy
Dynamic X-rays: detects abnormal movement
Neurological Examination
Blood Investigations

Dr. Daware explains the condition, discusses options, and ensures complete patient understanding.

How C1–C2 Fusion Surgery Is Performed

The surgery is performed under general anesthesia. Here is a simplified step-by-step process:

Step 1: Positioning

The patient is positioned prone (face down) to allow surgical access.

Step 2: Incision

A small incision is made at the back of the upper neck.

Step 3: Exposure of C1 and C2

Muscles are gently retracted to expose the bone.

Step 4: Screw Placement

Using navigation, fluoroscopy, or 3D imaging:

Screws are inserted into C1 lateral mass
Screws are inserted into C2 pedicle or pars

Step 5: Rod Placement

Rods connect the screws, stabilizing the segment.

Step 6: Bone Grafting

Bone grafts stimulate spinal fusion.

Step 7: Closure

The incision is carefully closed.

With advanced technology and high surgical expertise, the procedure is safe, precise, and effective.

Advantages of C1–C2 Fusion

Patients undergoing surgery with Dr. Ankit Daware benefit from:

Permanent stabilization of the cervical spine
Elimination of abnormal motion
Protection of spinal cord
Reduction in neck pain
Prevention of neurological deterioration
Restoration of balance and posture
Improved quality of life

Recovery After C1–C2 Fusion

Recovery depends on the patient’s condition and the complexity of the procedure.

Hospital Stay

Usually 3–5 days.

Neck Collar

A cervical collar may be advised for a few weeks.

Pain Management

Medications and muscle relaxants help reduce discomfort.

Physiotherapy

Rehabilitation begins gradually to improve posture, strength, and mobility.

Return to Normal Activities

Light activities: 2–4 weeks
Work: 4–8 weeks (depending on job type)
Complete fusion: 3–6 months