We reviewed four patients who underwent posterior C-D occipitocervical loop and autogenous bone graft. The mean postoperative follow-up period was 16 months. The indications for surgery were progressive neurological deficit, atlantoaxial instability and intractable pain. Of the four patients, one had os odontoideum, two rheumatoid arthritis and suboccipital dislocation combined fractures of C1 and C2. Bong union was confirmed in all cases at approximately 4 months postoperatively. Final outcome result was satisfactory in three patients and unsatisfactory in one patient. The cause of unsatisfactory result was recurrent neck pain secondary to swan neck deformity. The neurologic deficit were improved or remained same as preoperative status. Three patient were out of bed on average of the 14th day postoperatively. One patient could not ambulate due to tetraplegia who needed an artificial ventilator. There was no complication related to instrumentation.