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This retrospective, IRB-approved study examines 20 subjects with Fielding type 1 rotary subluxation, characterized by anterior subluxation of the facet on one side, with a<jats:italic>normal atlanto-dental interval<\/jats:italic>. Subjects diagnosed with a heritable connective tissue disorder, and AAI had failed non-operative treatment and presented with severe headache, neck pain, and characteristic neurological findings. Subjects underwent a modified Goel-Harms posterior C1-C2 screw fixation and fusion without complication. At 15\u00a0months, two subjects underwent reoperation following a fall (one) and occipito-atlantal instability (one). Patients reported improvement in the frequency or severity of neck pain (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), numbness in the hands and lower extremities (<jats:italic>P<\/jats:italic>\u2009=\u20090.001), headaches, pre-syncope, and lightheadedness (all<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01), vertigo and arm weakness (both<jats:italic>P<\/jats:italic>\u2009=\u20090.01), and syncope, nausea, joint pain, and exercise tolerance (all<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). The diagnosis of Fielding type 1 AAI requires directed investigation with dynamic imaging. Alignment and stabilization is associated with improvement of pain, syncopal and near-syncopal episodes, sensorimotor function, and exercise tolerance.<\/jats:p>","DOI":"10.1007\/s10143-020-01345-9","type":"journal-article","created":{"date-parts":[[2020,7,4]],"date-time":"2020-07-04T12:02:32Z","timestamp":1593864152000},"page":"1553-1568","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Atlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization"],"prefix":"10.1007","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9479-2368","authenticated-orcid":false,"suffix":"Sr","given":"Fraser C.","family":"Henderson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Rosenbaum","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malini","family":"Narayanan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Myles","family":"Koby","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Tuchman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter C.","family":"Rowe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clair","family":"Francomano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,7,4]]},"reference":[{"key":"1345_CR1","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1097\/00002517-199407010-00003","volume":"7","author":"K Abumi","year":"1994","unstructured":"Abumi K, Itoh H, Taneichi H, Kaneda K (1994) Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. 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