Abstract: Objective: To report the efficacy of applying four posterior fusion surgical methods for the treatment of upper cervical spine injuries. Methods In this group of 69 patients, wire was used for internal fixation in 39 cases (McGraw 25 cases, Brooks 14 cases), large bone block in 20 cases, Apofix plate clamp in 6 cases, and occipitocervical CD in 4 cases. The mean follow-up after surgery was 34 months, and the fusion rate of bone graft was 8296 (32/39) in the wire group, 75% (15/20) in the large bone block group, 100% (6/6) in the Apofix laminae group, and 100% (4/4) in the occipital CD group. Efficacy: excellent in 32 cases (4696), good in 16 cases (23%), acceptable in 11 cases (1696), poor in 10 cases (15%), including 7 deaths (10%). Conclusion The posterior fusion technique for upper cervical spine injury has its advantages and disadvantages, and the choice should be based on the patient’s injury and the operator’s experience, with the principle of safe operation, reliable bone grafting and reliable fixation; for those with serious damage to the local stable structure and weak internal fixation, timely postoperative strong external fixation can also achieve the therapeutic purpose.