Cranio-cervical stabilization using preformed Luque rectangles supplemented by autologous bone grafts was performed in 18 patients. Stability at the cranio-cervical junction had been impaired by a number of diseases including rheumatoid arthritis in 12 patients. Metastatic tumour in 5 patients and post-operative swan neck deformity in one patient. In all patients immediate stabilization as well as long-term bony fusion could be achieved, paralleled by improvement of the preoperative neurological condition in differing degrees. Surgery related complications were rare, although, considering the patient population treated, medical and anaesthesiological complications as a result of accompanying diseases may pose serious problems. The technical details of the surgical procedure are described and its application for the treatment of cranio-cervical instability is discussed.