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Magnetic resonance imaging can be employed to evaluate the transverse ligament, alar ligaments, and spinal cord [4, 24].
Moreover, surgical treatment must be performed for patients with C1 fracture complicated with type II odontoid fracture and atlas transverse ligament rupture.
The transverse ligament acts as the main stabilizing factor, preventing the anterior-posterior displacement of the atlas on the axis.
Should the sum of the overhang bilaterally exceed 7 mm, the transverse ligament is disrupted and the fracture unstable, requiring fixation.
Even the transverse ligament of the atlas (C1) articulates with the posterior aspect of the dens via a synovial joint.
The distinguishing feature of the axis is the odontoid process, also known as the dens or the odontoid peg, which a tooth-like process which projects superiorly from the body of the axis and is held in place by the transverse ligament of the atlas (Moore & Dalley 1999).
The original instability resulted from rheumatoid arthritis in nine, os odontoideum in five, Type II nonunions in eight, unstable bursts in seven, transverse ligament rupture in six, Type III ondontoid fractures in five.
When the investigators assessed inter- and intraob-server agreement, the highest reliability was found for the atlanto-occipital membrane and lowest for the transverse ligament.

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