Purpose Atlantoaxial osteoarthritis is a debilitating condition often resistant to conservative management. In refractory cases, C1-C2 fusion becomes a surgical option. Recent advancements, particularly in 3D navigation, have allowed for more precise and minimally invasive approaches, though there are limited reports on isolated percutaneous C1-C2 arthrodesis for osteoarthritis. This study aims to evaluate the feasibility, accuracy, and clinical outcomes of percutaneous C1-C2 transarticular screw fixation using 3D navigation in patients with disabling atlantoaxial osteoarthritis. Methods Ten patients (median age: 75.5 years), all female, underwent percutaneous C1-C2 screw fixation using the Magerl technique, guided by 3D navigation. Preoperative assessment included CT and contrast-enhanced imaging to ensure safe screw placement. Postoperative evaluations included pain assessment, radiographic analysis, and patient satisfaction. Results Transarticular screws were inserted in all of patients, with no significant intraoperative complications. Median operative time was 65 min with blood loss under 100 mL. Postoperative pain improved with the median VAS decreasing from 10 preoperatively to 1 at one year. Screw backout was observed in one patient without clinical repercussions. All patients expressed satisfaction and would undergo the procedure again. Conclusion Percutaneous C1-C2 transarticular screw fixation with 3D navigation is a safe and effective treatment for severe atlantoaxial osteoarthritis. It offers significant pain relief, accurate screw placement, and reduced postoperative morbidity. Preoperative anatomical evaluation remains critical to minimize risks. Level of Evidence Level III, Retrospective Cohort< Réduire