In a follow-up study of ten atlas and 85 axis fractures, 12% had residual symptoms in the form of local and radiating cervical pain. The residual symptoms were interpreted as a sign of a mild demyelinating process initiated by the trauma of the medulla. At least 22% of the accidents occurred while the person was under the influence of drugs or alcohol. Therefore, a wide range of residual symptoms (progressive or nonprogressive) could be attributed in part to abuse of drugs and alcohol. A permanent measurable loss of motion occurred following injury to the atlas or axis, irrespective of the modality of treatment. Cervical fusion created the greatest loss of motion and collar immobilization the least. Skull traction and a halo-vest were intermediate in patients with loss of motion, and the degree of loss of range was essentially equal. Residual symptoms, including pain, were found in 20% of those treated with a collar, 40% of those treated with surgical methods, 5% of those treated with traction, and 5% of those treated with a Halo-vest. Residual symptoms did not correlate at all with degree of displacement of the original fracture.