A modified plate and screw fixation technique for atlanto-axial subluxation was successfully used in 30 cases over 3 years and 9 months. The method involved using a 'radius-ulna' internal fixation stainless-steel plate and screws, providing immediate rigid internal fixation. This allowed early mobilization with minimal external support. Bone grafts facilitated bony fusion, and the technique achieved a 100% union rate with no complications. The average follow-up was 19 months. The method is biomechanically strong, utilizing the firm structure of the lateral masses of the atlas and axis. Occipito-cervical fusion can be achieved by modifying the technique. This method is suitable for complex congenital or traumatic craniovertebral instability where conventional methods have failed. The technique involves exposing the lateral masses and facet joints, carefully avoiding the vertebral artery, and using bone grafts for fusion. A 2–3 hole radius-ulna plate was placed over the lateral masses, with screws implanted in a sharp antero-medial direction. The technique was successful in all cases, with no morbidity or mortality. The method is MRI-compatible using titanium plates and screws. The procedure involved careful dissection, bone grafting, and precise screw placement. The technique allows for early mobilization and is effective for both atlanto-axial and occipito-atlanto-axial fusion. The results demonstrate the effectiveness of this method in achieving stable fixation and bony fusion in complex craniovertebral instability.A modified plate and screw fixation technique for atlanto-axial subluxation was successfully used in 30 cases over 3 years and 9 months. The method involved using a 'radius-ulna' internal fixation stainless-steel plate and screws, providing immediate rigid internal fixation. This allowed early mobilization with minimal external support. Bone grafts facilitated bony fusion, and the technique achieved a 100% union rate with no complications. The average follow-up was 19 months. The method is biomechanically strong, utilizing the firm structure of the lateral masses of the atlas and axis. Occipito-cervical fusion can be achieved by modifying the technique. This method is suitable for complex congenital or traumatic craniovertebral instability where conventional methods have failed. The technique involves exposing the lateral masses and facet joints, carefully avoiding the vertebral artery, and using bone grafts for fusion. A 2–3 hole radius-ulna plate was placed over the lateral masses, with screws implanted in a sharp antero-medial direction. The technique was successful in all cases, with no morbidity or mortality. The method is MRI-compatible using titanium plates and screws. The procedure involved careful dissection, bone grafting, and precise screw placement. The technique allows for early mobilization and is effective for both atlanto-axial and occipito-atlanto-axial fusion. The results demonstrate the effectiveness of this method in achieving stable fixation and bony fusion in complex craniovertebral instability.