Although congenital anomalies of the atlas have been well-documented, atlas anomalies of clefts and aplasia are rare. Anterior and posterior midline clefts of the atlas have been reported separately in some series. However, combined congenital anterior and posterior midline clefts of the atlas are reported rarely. Hence, we report a very rare case of combined congenital anterior and posterior midline clefts of the atlas associated with asymptomatic lateral atlantoaxial subluxation.