To explore the clinical outcomes and complications of C_1,2 pedicle screw internal fixation and bone graft fusion in treating upper cervical instability via manual blunt reaming.

From January 2011 to June 2016, 19 patients with upper cervical instability were treated by C_1,2 pedicle screw internal fixation and bone graft fusion. All cases presented with atlantoaxial instability such as cranio-cervical junction pain.

A total of 76 screws were placed in the 19 cases. No injuries to the spinal cord or large blood vessels were reported. Blood loss ranged from 200 to 630 mL, with an average of 340 mL. Operative time ranged from 1.5 to 3.5 h, with an average of 2.6 h. The patients were followed for 5-20 months, with an average of 8 months. No screw loosening or breakage occurred and bony fusion was achieved in all cases. The clinical symptoms were improved to some extent after operation. The preoperative JOA scores were 4.5-15.8 (average, 9); mean postoperative JOA score was 14.8 ± 2.3.

Manual blunt reaming is both safe and reliable for the placements of C_1,2 pedicle screws.