Aim:To evaluate the role of combination of C1-C2 transarticular fixation and C1 lateral mass screw fixation for the management of atlantoaxial instability. Materialsandmethods: This research covered all patients who were treated for AAI and had the combination procedure. The patients' records were retrospectively examined, and the clinical and radiological data recorded was analyzed in a comparable manner, comparing the preoperative and postoperative periods. The clinical results were evaluated by assessing the severity of pain before and after the surgery using a visual analog scale (VAS) for neck discomfort and pain in the C2 region. Furthermore, the Ranawat categorization of functional impairment was documented and then compared using the same approach. Results: Out of the total of 50 patients, the VAS ratings for neck discomfort were obtainable for 40 of them. The average preoperative VAS score for neck discomfort was 6.54±1.11, but at the first postoperative review it was 4.55±1.09. This difference was statistically significant (p =0.001) based on paired comparison. The Ranawat scores before and after surgery were obtained for a total of 50 patients. The Ranawat ratings showed improvement after surgery in 16 out of 50 patients (32%), remained unchanged in 32 patients (64%), and deteriorated in only 2 patients (4%). The Ranawat score showed a substantial improvement (p = 0.01) after surgery, similar to the VAS score, according to paired analysis. Postoperative imaging of all patients confirms the stability of the construct. Conclusion: The incorporation of C1 lateral mass screws into C1-C2 transarticular screw fixation for the management of atlantoaxial instability (AAI) is a very efficient and secure surgical technique. Our findings and expertise demonstrate that this technique is very advantageous in cases when decompression of the posterior components of C1 is necessary, and it may eliminate the need for supplementary posterior wiring often associated with posterior transarticular screw fixation.