The surgical treatment of refractory atlantoaxial subluxation still has many difficulties. Atlantoaxial posterior arch resection and decompression, occipitocervical implant fusion and fixation were often used in the past, but the compression of the spinal cord in front of the operation could not be directly removed, and the occipito-atlantoaxial joint and atlantoaxial joint were fixed and fused; the neurological recovery of the patient was limited after the operation, and the head and neck activities were obviously impeded. For this reason, some scholars have tried to adopt other surgical plans that can obtain direct decompression of the spinal cord without fusion of the occipital bone, such as: posterior odontoidectomy and decompression, atlantoaxial spine restoration and implant fusion and internal fixation, transtympanic anterior and posterior one-stage surgery for the treatment of refractory atlantoaxial dislocations, as well as anterior trans-oral pharyngeal atlantoaxial spine restoration and steel fixation for the treatment of refractory atlantoaxial dislocations, and so on. These methods have greatly enriched the clinical treatment of refractory atlantoaxial dislocation, but these methods have their own shortcomings and corresponding complications. In our study, we used the appropriate methods according to the different types of atlantoaxial dislocations to treat refractory atlantoaxial dislocations with posterior pedicle screws after the atlantoaxial vertebrae were loosened and repositioned. According to the type of atlantoaxial dislocation and the degree of displacement, different surgical approaches were used to release the atlantoaxial vertebrae, and in one stage, posterior pedicle screws were used (Summit system in 14 cases and Oasys system in 5 cases) combined with intraoperative cranial traction to complete atlantoaxial repositioning, fixation, and implant fusion. Atlantoaxial pedicle screws were 22-26 mm in length and 3.5 mm in diameter; pivot pedicle screws were 22-28 mm in length and 3.5 or 4.0 mm in diameter; and C3 pedicle screws were 22-24 mm in length and 3.5 mm in diameter.The patients were routinely protected by head-cervical-thoracic braces for 2-3 months after surgery.