Posterior transarticular screw fixation of the C1-C2 complex has become an accepted method of arthrodesis for patients requiring posterior C1-C2 fusion. Since 2000, four patients (2 males and 2 females) were treated with this surgical approach for management of atlantoaxial instability, including odontoid fracture with unilateral C1-C2 luxation, odontoid pseudarthrosis, complex congenital malformation of the craniovertebral junction and rheumatoid arthritis. All patients underwent stabilization with 2 transarticular C1-C2 screws, without any posterior interspinous graft. Patients were maintained in a rigid cervical orthesis 3 months postoperatively. Results were good, without any complication, after a short mean follow-up (8 months). Technical aspects of the technique are reported, The risk of screw malpositioning and vertebral artery or neural injury is minimal and can be lowered by using preoperative CT scan and MRI, and by using intraoperative fluoroscopy. Transarticular C1-C2 screw fixation proves to be a major surgical approach for treatment of atlantoaxial instability.