Objective: The goal of this study was to evaluate the impact of C-1-C-2 pedicle screw fixation on the occipitoatlantal angle and subaxial cervical spine for a pediatric population, and the clinical efficacy and adjacent-segment degeneration after C-1-C-2 pedicle screw fixation with a minimum of 2 years of follow-up. Methods: Twenty-two pediatric patients with atlantoaxial dislocation who were enrolled in this study underwent atlantoaxial pedicle screw fixation. The correlation between C-0-C-1, C-2-C-7, and C-1-C-2 pre-and postoperative sagittal angles was assessed using plain radiographs, and adjacent-segment degeneration (ASD) and JOA scores (Japanese Orthopaedic Association scores) were evaluated after atlantoaxial pedicle screw fixation. Results: The C-1-C-2 angle increased from 16.1 +/- 13.37 to 28.1 +/- 5.1 degrees (p < 0.01). The pre- and postoperative C-1-C-2 angles were negatively correlated with the pre-and postoperative C-0-C-1 and C-2-C-7 angles, respectively. In accordance with the optimal atlantoaxial fusion angle (25-30 degrees) obtained from the literature, postoperative JOA scores were greater in the groups with angles of more than 30 degrees and less than 25 degrees, although the difference in ASD was not statistically significant. Postoperative JOA scores were not relevant to the postoperative C-1-C-2 angle; however, there was a positive correlation between JOA improvement rate and the change of the C-1-C-2 angle postoperatively. Conclusion: Atlantoaxial pedicle screw fixation can be used easily to reduce atlantoaxial dislocation in the pediatric population; however, outside the range of the optimal atlantoaxial fusion angle it can change the occipitoatlantal angle and subaxial alignment, which induces ASD and influences the clinical efficacy. It is necessary to achieve an optimal atlantoaxial angle when using atlantoaxial pedicle screw fixation. (C) 2017 S.Karger AG, Basel