Abstract: [Objective] To introduce surgical technique and clinical outcomes of single-stage anterior cervical retropharyngeal approach atlantoaxial release and sequential posterior fixation and fusion for irreducible atlantoaxial dislocation. [Methods] From March 2016 to January 2019, a total of 38 patients with irreducible atlantoaxial dislocation underwent single-stage anterior cervical retropharyngeal approach atlantoaxial release and sequential posterior fixation and fusion. Smith-Robinson approach was applied to expose the ventral structure of the atlantoaxial articulation, the scar and ligament around the atlantoaxial articulation were resected to achieve atlantoaxial release, then posterior reduction, screw fixation, and bone graft fusion were performed. [Results] All the surgeries were achieved successfully without serious complications such as spinal cord and vertebral artery injury. All the patients were followed up for an average of (32.54±7.63) months, bone fusion was achieved in all of them, no implants failure and atlantoaxial re-dislocation were identified during the follow-up. The postoperative ADI and CMA improved significantly, JOA scores significantly increased at the final follow-up. [Conclusion] Single-stage anterior cervical retropharyngeal approach atlantoaxial release and sequential posterior fixation and fusion can achieve satisfactory atlantoaxial release and is a reliable strategy for irreducible atlantoaxial dislocation.