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Purpose: Atlantoaxial fixation techniques using anterior and posterior aflantoaxial transarticular screws have promising clinical results.However, few reports have compared the anatomical risk of vertebral artery (VA) injury associated with these screws.The purpose of this study was to evaluate the trajectories of anterior and posterior atlantoaxial transarticular screws using 3-dimensional (3D) computerized tomography.Methods: A total of 60 consecutive patients with cervical lesions were evaluated using 3D images reconstructed by a rapid 3D system.We compared the maximum possible diameters of the anterior and posterior atlantoaxial transarticular screw trajectories and examined whether the diameters were limited by the bony structures in the trajectories that were 3.5 mm in diameter.Results: We found that the maximum mean diameter differed significantly between the trajectories of 120 anterior and posterior atlantoaxial transarticular screws.In screw trajectories ≤ 3.5rmm in diameter, 19.2% of the posterior transarticular screw trajectories were judged risky, and the maximum diameter of the anterior transarticular screws >3.5mm all.and all the anterior transarticular screw trajectories are >3.5rmm, judged safe.Conclusion: From an anatomical perspective, anterior atlantoaxial transarticular screw placement may have less anatomical risk of VA injury than a posterior placement.Preoperative 3D evaluations may be useful for choosing the best surgical technique.(193 < 250)