Objectives: The present study was designed to determine the surgical yield of cervical C1-C2 fixation by implantation of hooks for the treatment of patients with C1-C2 instability. Patients and Methods: The present study included 20 patients; assigned for C1-C2 fusion for non-neoplastic disease; diagnosis and inclusion was confirmed by magnetic resonance imaging (MRI). The applied technique for C1-C2 hook fixation was conducted according to Holness et al., using either iliac crest or artificial bone graft. Postoperative bracing (firm collar) was applied for 8-12 weeks. Outcome Measures included radiological evaluation of successful bone fusion, neurological evaluation using the American Spinal Injury Association (ASIA) motor score, neck and arm pain scoring, neck disability index (NDI) and the functional independence measure (FIM) presented as total motor score. Evaluations were conducted preoperatively and at end of follow-up period of at least 6 months. Results: The study included 11 patients with odontoid fracture, 3 transverse atlantal ligament injuries, 4 os odontoideum and 2 had rheumatoid C1-C2 instability. Preoperative neurological evaluation detected 8 patients were ASIA grade B, 7 were ASIA grade C and 5 patients were ASIA grade D. All surgeries were conducted smoothly without intraoperative complications and an autogenous iliac crest graft was applied in 18 patients, while artificial bone grafts were used in 2 patients. Radiological examinations conducted at end of follow-up period at least 6 months showed evidence of fusion, defined as the absence of C1-C2 movement on lateral flexion-extension radiographs and continuity of trabecular bone formation between C1 and C2 across the graft and disappearance of spine instability in 13 patients (65%). Postoperative clinical evaluation revealed significant improvement of neurological ASIA grading and 7 patients (35%) showed complete recovery without motor or sensory deficit. Both pain and neck disability scores was decreased postoperatively compared to preoperative scores. Postoperative total FMI motor power scoring was higher compared to preoperative measures. Conclusion: Posterior C1-C2 fixation using c1 c2 hooks is technically simple to apply and can be done safely without concomitant intra- or postoperative complications. High success rates in obtaining fusion and significant improvement at the end of follow-up with high quality-of-life scores make this method of posterior fixation and fusion an ideal surgical modality for higher cervical spine instability.