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Postoperative computed tomography (CT) was performed to check screw malposition or construction failure. Of the 10 C1 pedicle screws on postoperative CT, 20% of screws (grade A) were in the ideal position while 80% of screws (grade occupied a safe position. Overall, 100% of screws were safe (grade A or . There were no iatrogenic neurological deficits, VA injury. Freehand placement of the C1 pedicle screw through the direct visualization technique of the pedicle and serial dilatation technique is safe and effective without intraoper
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