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OBJECTIVE AND IMPORTANCE: Transarticular screw fixation of the C1–C2 complex provides immediate rigid fixation of the unstable spine. The technique is not feasible in a certain proportion of patients because of the position of the vertebral artery or the patient’s body habitus.

CLINICAL PRESENTATION: The authors describe a rigid screw technique for the surgical treatment of a woman who was excluded as a candidate for C1–C2 transarticular screw fixation.

TECHNIQUE: C1–C2 pedicle screw fixation was achieved using a fixed moment arm cantilever beam system. This system provided immediate rigid fixation of the C1–C2 complex in a patient who was not a candidate for transarticular screw fixation.

CONCLUSION: This technique is technically more forgiving than posterior transarticular screw fixation and may be applied to a broader spectrum of patients.