C1-C2 fusion is a surgical procedure used to treat certain conditions affecting the upper part of the neck, where the first (C1) and second (C2) cervical vertebrae are located. The cervical spine, which includes these vertebrae, plays a crucial role in supporting the head and enabling its movements. When problems occur in this region, such as instability or severe injury, C1-C2 fusion may be recommended as a treatment option.

In this article, we will explain what C1-C2 fusion is, why it is performed, how it is done, the recovery process, potential risks and benefits, and answer some common questions about the procedure.

What is C1-C2 Fusion?

C1-C2 fusion, also known as atlantoaxial fusion, is a surgical procedure in which the first cervical vertebra (C1) is fused with the second cervical vertebra (C2). The aim is to stabilize the neck and prevent excessive movement between these two vertebrae.

Why is C1-C2 Fusion Performed?

C1-C2 fusion is performed for several reasons, including:

  1. Instability: When there is excessive movement or misalignment between the C1 and C2 vertebrae, it can lead to instability in the neck. This instability can cause pain, nerve compression, and difficulty in head movement.
  2. Fractures: Severe fractures of the C1 or C2 vertebrae due to trauma or injury may require fusion to promote healing and stability.
  3. Congenital Conditions: Some individuals are born with abnormalities in the C1-C2 region, such as atlantoaxial instability. Fusion may be needed to correct these issues.
  4. Degenerative Conditions: Conditions like arthritis or other degenerative diseases can affect the stability of the C1-C2 vertebrae, necessitating fusion to provide support.

How is C1-C2 Fusion Done?

The C1-C2 fusion procedure is typically performed under general anesthesia, meaning the patient is asleep during the surgery. Here are the basic steps:

Step 1: Incision: The surgeon makes a small incision at the back of the neck, exposing the cervical spine.

Step 2: Bone Preparation: The surgeon removes any damaged or problematic tissue and prepares the surfaces of the C1 and C2 vertebrae for fusion.

Step 3: Bone Grafting: A bone graft is placed between the C1 and C2 vertebrae to encourage them to fuse together over time. The bone graft acts as a bridge, promoting the growth of new bone between the vertebrae.

Step 4: Fixation: Metal screws, rods, or plates may be used to hold the C1 and C2 vertebrae in place while the fusion process occurs. This fixation helps to stabilize the area during the healing process.

Step 5: Closure: After the fusion and fixation are completed, the incision is closed with sutures or staples.

Recovery Process:

The recovery from C1-C2 fusion surgery can vary from person to person, but here are some general points:

  1. Hospital Stay: After the surgery, you will spend some time in the hospital for monitoring and initial recovery. The length of the hospital stay depends on the individual and the complexity of the surgery.
  2. Neck Brace: You may need to wear a neck brace for several weeks or months to support the healing process and prevent excessive neck movement.
  3. Physical Therapy: Physical therapy may be recommended to help restore neck strength and flexibility gradually.
  4. Healing Time: It can take several months for the bone graft to fuse the C1 and C2 vertebrae together completely.
  5. Follow-up: Regular follow-up visits with your surgeon are essential to monitor your progress and ensure proper healing.

Potential Risks and Benefits:

As with any surgical procedure, C1-C2 fusion carries both risks and potential benefits. It’s essential to discuss these with your surgeon before making a decision. Here are some of the common risks and benefits:


  • Infection at the surgical site
  • Nerve or spinal cord injury
  • Failure of bone fusion
  • Blood clots
  • Anesthesia-related complications


  • Increased stability of the C1-C2 vertebrae
  • Relief from pain and improved neck function
  • Correction of spinal deformities
  • Enhanced quality of life


Q1: How long will I need to stay in the hospital after C1-C2 fusion surgery? A: The hospital stay duration can vary, but it typically ranges from a few days to a week, depending on your condition and the surgeon’s assessment.

Q2: Will I be able to move my neck normally after the surgery? A: While you may regain some neck movement, full range of motion may not be possible due to the fusion. However, many people experience significant improvement in neck function after recovery.

Q3: How long does it take to recover from C1-C2 fusion surgery? A: The complete recovery period can take several months. It depends on factors like your overall health, the extent of the surgery, and how well you follow post-operative instructions.

Q4: Are there non-surgical alternatives to C1-C2 fusion? A: In some cases, conservative treatments like physical therapy, medication, or bracing may be attempted initially. However, surgery may be necessary if these methods do not provide adequate relief.

Q5: What should I avoid during the recovery period? A: Your surgeon will provide specific instructions on activities to avoid during your recovery, which may include heavy lifting, strenuous exercise, or certain neck movements.

Q6: Is C1-C2 fusion a common procedure? A: C1-C2 fusion is not as common as other spinal surgeries, but it is performed when needed to address specific conditions affecting the upper cervical spine.


C1-C2 fusion is a surgical procedure aimed at stabilizing the upper part of the neck by fusing the first and second cervical vertebrae. It is performed to address conditions such as instability, fractures, and congenital or degenerative issues. While the procedure carries risks, it also offers potential benefits in terms of pain relief and improved neck function.

As with any medical decision, it is essential to have a thorough discussion with your healthcare provider to understand your specific condition, the recommended treatment, and what you can expect during the recovery process.

Dr. Priyesh Dhoke

Dr Priyesh Dhoke M.B.B.S., M.S. (Orthopaedics), F.A.O.S.(Australia) AO Spine...

Quick Query