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What Is Atlantoaxial Subluxation?

An X-ray of the neck, including vertebrae.
A woman wearing a cervical collar for an atlantoaxial subluxation.
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  • Written By: Tricia Ellis-Christensen
  • Edited By: O. Wallace
  • Last Modified Date: 17 August 2014
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Atlantoaxial subluxation refers to a condition affecting the top of the spine. Subluxation is another term for dislocation, and atlantoaxial references the top two cervical vertebrae. When dislocation or instability occurs, it may be mild to serious and caused by many different factors. In worst-case scenarios the loosened spine has the potential to compress the spinal cord creating permanent damage or death, but some people may have milder cases that resolve in a few weeks with minimal treatment.

There isn’t a single cause of atlantoaxial subluxation. It can occur when people undergo a major neck trauma. Sometimes adults develop it as a result of arthritic conditions, particularly rheumatoid arthritis. It may happen suddenly after any illness that affects the respiratory tract, like pneumonia, and it can appear after surgery on the spine. Congenital conditions that create poor muscle or connective tissue tone, such as Marfan’s or Down syndrome have also been associated with this spine disorder, and in other instances the condition occurs alone in children as a congenital defect.

Symptoms of atlantoaxial subluxation may vary. The neck can look twisted, but it might not. Some experience headache or pain in the cervical spine. Most often, people don’t have symptoms of less severe forms of the condition, which can be dangerous. Participation in things like sports, given the instability of the neck, risks far greater injury.

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When the condition is suspect, it can usually be easily diagnosed through a variety of scans. These include computed tomography (CT) scans, x-rays, and magnetic resonance imaging (MRI). Given diagnosis, physicians turn to treatment.

In minor atlantoaxial subluxation, the goal may simply be to provide neck stability, which could be accomplished by wearing a soft or hard cervical collar. Should the condition be more severe, hospitalization might be required and traction or greater stabilizing techniques could be employed to correct the “free-floating” neck and to protect against injury to the spinal cord. Sometimes these measures are inadequate to the treat the problem.

The most aggressive steps taken to address atlantoaxial subluxation are surgical. Spinal fusion can prevent misalignment, though it may also slightly reduce range of motion. More than one surgery could be required, depending on cause of the illness or degree of its severity. If the subluxation has created spinal compression, outlook is not always fully positive. Damage to the cord, especially of a significant nature, may not be repairable in all cases, though in some instances neurosurgeons or orthopedic surgeons are able to successfully restore some or all function.

Many people recover fully from atlantoaxial subluxation, particularly if the condition is noticed early. Those who may be predisposed to this irregularity in the cervical spine should watch for symptoms. Unfortunately, it’s not always possible to predict the condition’s occurrence, especially when it results from injury or any form of illness affecting the respiratory tract.

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