Objective To compare the pullout strength between spinous process screwing and pedicle screwing in posterior internal fixation of C2. Methods Eight fresh human cadaveric C2 were harvested.Spinous process screws were placed on one side of the C2 and pedicle screws were placed on the other side in a random manner.Cortical bone screws of 4.0 mm in diameter were used.The starting point for spinous process screw insertion was located at the junction of the lamina and the spinous process and the direction of the screw was about 0° caudally in the sagittal plane and about 0° medially in the axial plane.Pedicle screws were placed under direct visualization.After screw placement,each aet of vertebral bodies were mounted in a custom jig for axial pullout testing using a servo-hydraulic testing machine.The load-displacement curves were obtained for each screw pullout. Results The mean pullout strength for the spinous process screws was 387.56 ± 137.73 N,not significantly different from that for the pedicle screws (465.25 ± 214.32 N)( t =-0.862,P =0.403).The working length for the spinous process screws (21.42 ± 1.14 mm) was significanfly shorter than for the pedicle screws (23.16 ± 1.01 mm) ( t =4.368,P ＜0.001). Conclusion Since spinous process screws have similar pullout strength as compared with pedicle screws,they are biomechanically feasible in clinical application.