Plain radiograph of cervical spine of a 12-year-old boy diagnosed with LCH showing destruction and atlanto-axial instability, surgery was mandated to avoid neurological affection. (A) Preoperative plain radiograph showing C1–C2 instability. (B) CT scan showing the instability and lateral tilt of C1 over C2. (C) Postoperative radiograph showing C1–C2 fixation. (D) Follow-up radiograph after 1 year. (E) Follow-up CT scan after 5 years showing complete fusion of C1–C2.