Screw fixation of the second cervical vertebra (C2), also known as the axis, is a mainstay in the management of upper cervical trauma and instability. The safety of C2 fixation via translaminar screw (TLS) and transpedicular screw (TPS) techniques is fundamentally influenced by individual anatomical variability. This study addresses the need to move beyond reliance on mean values by establishing quantifiable, integrated risk thresholds for both fixation pathways within the study population.