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Atlanto-axial subluxation (C1-C2 subluxation) and back pain
Last reviewed: 23.04.2024
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Atlanto-axial subluxation is the inability between the first and second cervical vertebrae, which can occur only when the neck is bent.
Atlanto-axial subluxation can be the result of severe trauma, such as high-speed traumatic braking, however, it can also occur without injury in patients with rheumatoid arthritis, juvenile rheumatoid arthritis, or ankylosing spondylitis. Atlanto-axial subluxation is usually asymptomatic, but can cause faint neck pain, occipital headache, less intermittent (potentially fatal) cervical spinal compression.
Atlanto-axial subluxation is diagnosed by radiographs, however, radiography may not be fully detected until a study in flexion is conducted. Flexion, performed by the patient, shows the dynamic instability of the entire cervical spine. If the radiographs are normal, and suspicions of subluxation are serious, an MRI should be performed that is more sensitive than X-rays. MRI also makes it possible to diagnose spinal compression and should be performed immediately, with suspicion of spinal cord compression. Indications for the treatment are pain, neurological deficit, and possible instability of the vertebrae. Treatment includes symptomatic measures, cervical immobilization, usually with a hard neck collar. To stabilize the vertebrae, surgical treatment may be required.
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