BACKGROUND Surgical intervention is a critical treatment approach for symptomatic atlantoaxial dislocation. However, vertebral artery injury remains a significant challenge during such procedures. We present a case of successful treatment of atlantoaxial dislocation with concurrent vertebral artery injury using interlaminar screw technology, and review the relevant literature. CASE SUMMARY A 69-year-old female patient, with no history of trauma, was diagnosed with atlantoaxial dislocation based on X-ray, computed tomography (CT), and magnetic resonance imaging. Preoperative CT angiography (CTA) revealed vertebral artery developmental anomalies, and she underwent posterior cervical surgery. Postoperative follow-up showed improvement in the patient's clinical symptoms such as unstable walking and dizziness, as well as functional scores compared to pre-surgery. Intraoperative vertebral artery injury was successfully managed, and postoperative CTA review revealed no complications related to vascular damage. CONCLUSION Thorough preoperative evaluation, such as CTA imaging, and the surgeon's expertise in various spinal screw placement techniques are crucial for improving the success rate of atlantoaxial dislocation surgeries.