Atlanto-occipital malformation refers to the abnormal development of the base of the occipital bone and the first two cervical vertebrae, which is usually combined with the developmental abnormality of the nervous system and soft tissues. Atlanto-occipital malformations usually include: flattened cranial base, depression of the cranial base, fusion of the atlanto-occipital, cervical vertebral segmentation, atlantoaxial dislocation, and cerebellar submental herniation malformations. Clinical manifestations of atlanto-occipital malformations: Due to the different types of malformations, there are often different clinical manifestations, which usually include limb weakness, numbness, dizziness, ataxia, nystagmus, hobbling, paralysis, and urinary incontinence. Spinal cord cavernous disease usually coexists with atlanto-occipital malformation, and its clinical manifestations mainly include separation of pain and temperature sensation in the cervicothoracic segment, and atrophy and deformity of hand muscles. Treatment of atlanto-occipital malformation: For the treatment of patients with atlanto-occipital malformation and spinal cord cavernous disease, there are different opinions at home and abroad, including drugs, acupuncture, physiotherapy and other conservative treatments, and when the conservative treatments are ineffective, surgical treatment can be considered, and the surgery mostly adopts the suboccipital posterior median approach suboccipital decompression surgery. Before surgery, three-dimensional imaging of the neck bone was performed to understand the development of the vertebral body, vertebral plate, and lateral block, and suboccipital decompression and occipitocervical fixation and fusion were performed for the patients. Simple suboccipital decompression, decompression usually destroys the vertebral plate, intervertebral joints, thus affecting the stability of the cervical spine, the patient’s symptoms can be relieved in the short term after the operation, but with the prolongation of time, the unstable vertebral body may produce displacement, resulting in stenosis of the spinal canal, spinal cord compression, which may further aggravate the symptoms, if the use of suboccipital decompression and occipital-cervical fixation and fusion, the chances of the occurrence of cervical spinal instability after the operation is very low, thus If suboccipital decompression and fixed cervical fusion are used, the chance of postoperative cervical instability is very low, thus consolidating the therapeutic effect, and the chance of postoperative recurrence of symptoms is greatly reduced. In the treatment of atlantoaxial dislocation, orthopaedic departments often use anterior decompression and posterior fusion and fixation for two surgeries, but the posterior decompression and internal fixation adopted by our hospital can achieve the purpose of two surgeries in one operation, and the effect is very good, which is carried out by few hospitals at home and abroad, and the cost is small, the curative effect is good, and the recurrence rate after surgery is very small. Atlanto-occipital deformity surgical treatment: usually use suboccipital posterior median approach, the operation reveals the posterior border of occipital foramen magnum, exposes atlantoaxial and cardinal vertebrae as well as cervical 3-5 vertebral plates and spinous processes, bites off part of the bone at the posterior border of occipital foramen magnum as well as cervical 1-2 vertebral plates and spinous processes, reveals dura mater, exposes the surface of the arachnoid membrane on the surface of the spinal cord, electrocautery herniated lower edge of the cerebellar tonsils so that it retracts above the posterior border of the occipital foramen magnum and adopts the Cotex artificial dura mater decompression. The dura mater was sutured, and after suboccipital decompression was completed, the lateral blocks of neck 2-4 were nailed, and an occipitocervical fusion internal fixation system was selected, usually at an angle of 105°, which was fixed to the occipital bone with screws, and after the fixation was completed, the muscles and the skin were closed one by one with sutures. After surgery, the patient wears a neck brace for 4-8 weeks. Atlanto-occipital deformity in short and thick necks Atlanto-occipital deformity occurs more often in people with short and thick necks, because the mobility of the joints is greater and the degree of wear and tear is higher during head-turning activities, thus making them more susceptible to the development of atlanto-occipital deformity. At the same time, patients are reminded that atlanto-occipital deformity combined with subcerebellar tonsillar hernia and spinal cord cavernous disease is caused by congenital dysplasia, which starts in adulthood, and there is no medication available to treat it, and surgery is the only effective treatment. Initially, patients will gradually develop neck and shoulder pain, arm numbness, weakness and unsteady walking. If not treated in time, the prognosis will be very poor in the late stage.