AAD is common. Trauma in our country is the commonest cause of AAD. Stabilization including occiput is a better construct for a good long term results. C1 and C2 alone can be stabilized by bilateral cortico cancellous lateral mass screws ( Magerl Technique) but inclusion of occiput in the process of fusion is better in our country where frequently carry loads on their heads. The stabilization is carried out with a contoured metallic loup. 8 drill holes are made in the occipital bone 4 wires are passed, one through two holes. Sublaminar wires are passed through C1 and C2 on either side of the spinous processes. The contoured loup is fixed in position by tightening the wires around the loup. Cortico cancellous bone taken from the iliac crest is then laid down by onlay technique to achieve bony fusion.

Contoured Loup	Magerl technique

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