Diagnosis and treatment of atlantoaxial dislocation and atlantoaxial subluxation in India (2023)

What is atlantoaxial dislocation?

From top to bottom in humans, the vertebrae are:

  • Cervical spine: 7 vertebrae (C1-C7)
  • Thoracic spine: 12 vertebrae (T1-T12)
  • Lumbar spine: 5 vertebrae (L1–L5)

C1 (atlas) and C2 (axial) are the first two vertebrae at the top of the spine, located just below the skull. The atlas and axial vertebrae are the allied collection of ligaments and blood vessels that pass from the spine to the brain. The condition where the C1 and C2 vertebrae in the neck become slightly misaligned or displaced is known as atlantoaxial subluxation. Although nearly all vertebrae in the spine are relatively identical in form and function, the atlas and axis are unique in both appearance and function. Dr. Sumit Sinha is one of the best Neurosurgeons for C1 C2 Rotational Subluxation treatment in Gurgaon, India.

Review of a happy patient operated by Dr. Sumit Sinha for Spine Surgery.

The atlantoaxial complex is primarily responsible for

  • head rotation
  • Allowing the neck to turn left and right.
  • Protect the spinal cord from injury.

Due to its role in movement, it is unfortunate that this atlantoaxial complex quickly becomes prone to injury.

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(Video) C1-C2 instability (Atlanto-Axial instability or AAI) - Causes, symptoms and Treatment.

Causes of atlantoaxial subluxations

Although people of all ages can have this condition, this C1-C2 shift is commonly seen among teenagers. Experts around the world have been looking for treatments that can take care of this condition with less abrasive and effortless techniques. Some causes of atlantoaxial dislocation are listed below:

  • it is sudden
  • Traffic accidents and sports injuries
  • Genetic disorders of connective tissues
  • sports injury
  • automobile or car accident
  • osteoporosis
  • Chronic inflammatory state of the joints.
  • Rheumatoid arthritis

The ligaments that hold the Atlantoaxial Complex together can be weakened in unreasonable conditions such as Down syndrome or rheumatoid arthritis, and they can also be injured in trauma.

When the bones or ligaments of the C1-C2 complex are injured, the spinal cord is at particular risk of injury and surgical treatment such as c1 c2 rotatory subluxation treatment is often required. Treatment of atlantoaxial dislocation is often difficult as the bone structure of the atlantoaxial is very complex and the vertebral arteries passing through the C1-C2 bones go to the brain.

Like any other injury or damage to your body, C1-C2 subluxation can also occur at different levels or the damage level of the injury can also vary, so the way to treat it is different. The extent of the dislocation is the deciding factor for the level of treatment you may require. Get in touch with Dr. Sumit Sinha for treatment of Atlantoaxial Dislocation, Atlantoaxial Subluxation and c1 c2 Rotational Subluxation at Paras Hospital, Gurgaon, India.

Atlantoaxial Dislocation and Atlantoaxial Subluxation Diagnosis and Treatment

Treatment of Atlantoaxial Dislocation Treatment of Atlantoaxial Subluxation c1 c2 Treatment of Rotational Subluxation The human body is very complex and is made up of myriads of nerves. The spine is the most sensitive visceral part of the body. The spinal cord is a bundle of nerves that carry messages between the brain and the rest of the body. The spinal cord and vertebral column are protected by a defensive membrane, forming the vertebral column. The vertebrae protect the spinal cord. If any damage to the vertebrae occurs, then this requires additional care and treatment.

Atlantoaxial dislocation is a rare but dangerous condition that disproportionately affects certain patient populations. A variety of etiologies contribute to atlantoaxial dislocation, and underlying causes or predisposing factors must be considered to maximize timely and effective treatment. Various anterior and posterior surgical techniques are suitable for atlantoaxial fusion. Each technique has its indications, contraindications, risks and technical difficulties. Future prospective clinical trials are needed to more adequately determine which surgical technique is optimal based on the respective clinical presentations. Get in touch with Dr. Sumit Sinha for Atlantoaxial Dislocation Treatment, Atlantoaxial Subluxation Treatment and C1 C2 Rotational Subluxation Treatment in Gurgaon, India.

Why is treatment of atlantoaxial dislocation desirable?

  • Minimally invasive surgery with small cuts and minimal scarring.
  • Higher Success Rate: Success rates of atlantoaxial dislocation treatment in India are higher than in any other country.
  • Early recovery: patients recover in a shorter time.
  • Less Blood Loss: There is very little blood loss during the procedure.
  • Cost-effective: The treatment of atlantoaxial dislocation is comparatively significantly less than in other countries.

Dra Sumit Sinha | Best surgeon for treatment of atlantoaxial dislocation

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Atlantoaxial subluxation: symptoms and treatment

One of the most common symptoms of atlantoaxial subluxation is pain around the neck. In the skull, where the C1 and C2 vertebrae meet, subluxation of C1 and C2 can cause stress or pressure on the spinal nerves (also known as cervical nerves) and the spinal cord in the neck. As the spinal nerves direct the ligaments in the upper extremities, any stressful pressure applied to these nerves is caused by a C1 and can cause different symptoms in the upper extremities. Some of these symptoms include:

  • Muscle weakness, especially in the arms or legs.
  • The continual occurrence of the condition in which the muscles continuously contract.
  • decreased agility
  • Change in the way an individual walks.
  • Pain that feels like pin pricks
  • Tires quickly when walking
  • Tingling, numbness or pain in the legs, neck, shoulder or arm
  • head tilted to one side
  • Inability to turn the neck comfortably or hold it
  • loss of bladder control
  • chronic body pain
  • Itchy back or upper back region
  • limited movements

Treatment of atlantoaxial subluxation

Treatment of atlantoaxial subluxation depends on the person's symptoms. With the advent of technology and scientific advances, various treatments such as physiotherapy, massage therapy orTraditional Ayurvedic Treatmentswere introduced to treat dislocation due to atlantoaxial subluxation. The treatment of atloaxial subluxation is categorized into different sections, and each one has its own procedures and way of treating the situation. These are some of the treatments for atlantoaxial subluxation:

  • Physical therapy
  • massage therapy
  • chiropractic therapy
  • Use of walker/therapeutic orthosis

C1-C2 (or Atlantoaxial) subluxation should be treated as soon as possible as it can lead to a potentially serious threat to other parts of the body or it can cause complications in the nervous system that can lead to immobility or paralysis in most cases. But luckily, with regular care, medication, and a willingness to ease the pain, atlantoaxial subluxation can be treated more quickly!

An individual who has a minor atlantoaxial subluxation can usually be treated with a neck brace which helps to immobilize the neck which in turn allows the injured neck joint to rest and recover satisfactorily. In some cases, physical therapy can also help.

A person with a large (very bad) atlantoaxial subluxation may often need neck surgery. If you want to avoid surgery, you must be very careful when playing sports or other physical activities. The neurosurgeon will guide you towards sports and activities that are safe for you.

How do doctors test for atlantoaxial dislocation?

If you have symptoms of atlantoaxial dislocation, your surgeon will suggest several diagnostic tests and X-rays to confirm the condition and also to find out the severity of the dislocation. As per the normal protocol, the patient will first be asked to have an x-ray, and if the x-ray results are different than normal (abnormal), the surgeon will order another imaging test, such as a nuclear magnetic resonance (NMR). ). ) or a computed tomography (CT).

  • X-ray images are used to look at the locations and connections of the first two vertebrae C1-C2 to locate the displacement. This must be done carefully to avoid further misalignment.
  • Magnetic resonance imaging is used to detect any type of spinal compression and to assess the alignment of the vertebrae. An MRI can also show soft tissue injuries and alert your surgeon to other problems.
  • A CT scan can show fractures and all types of bone displacement of the atlas. The severity of the condition will depend on the amount of pressure on the spinal cord and how long you have had the condition.

Care after treatment of atlantoaxial dislocation

After successful surgery, the patient needs to stay in the Intensive Care Unit for at least one day and then can stay in the general ward. After the surgery, the patient usually needs to stay in the hospital for about a week. Walking begins on the second postoperative day. After discharge from the hospital, the surgeon usually requests a follow-up at least once a week after discharge on an outpatient basis to make sure everything is fine before you go home; therefore, we recommend staying in India after discharge for 10-15 days.


Recovery from atlantoaxial instability (or subluxation)

The chances of recovery from successful treatments of atlantoaxial instability are good. Even so, the patient should be aware of any symptoms of complications, such as

  • Weakness of the laryngeal muscles,
  • Pain near the pin area, which means infection,
  • Fracture or migration of nails or bones.
  • Some people may have difficulty swallowing, but this will go away on its own within 1 to 2 weeks.

Cost of Atlantoaxial Dislocation Treatment in Gurgaon: Why Us?

Spine Neurosurgeons in Gurgaon have extensive experience in treating these disorders. All the surgical techniques used to treat atlantoaxial instability (C2 translaminar screws) are successfully practiced in Gurgaon and are now famous all over the world.

The advancement and development of medical facilities has provided various options to provide the best patient care. One of these advances for the treatment of atlantoaxial dislocation is endoscopic spine surgery, which offers the best results. Because it is a very advanced procedure, it can involve a huge cost. Atlantis dislocation surgery costs a fortune in many developed countries like USA, UK, Canada, Australia etc. Many countries also face the challenge of long and unpredictable waiting lists for this surgery. Also, many underdeveloped and developing countries do not have reliable facilities for treating c1 c2 rotatory subluxation (atlantoaxial dislocation).

All of the above makes Gurgaon, India the best place for treating atlantoaxial dislocation. You can do this with the best surgeons and technology at a very low price and without a waiting line. At Paras hospital, we offer the best Endoscopic Spine Surgery in Gurgaon with latest technology and best surgeon at nominal prices.

How many international patients came to India for treatment of atlantoaxial dislocation?

The main reason for the increase in the number of foreign patients coming to India for medical treatment is the availability of world famous doctors in India for atlantoaxial subluxation treatment, low prices and excellent tourism options, air connectivity and many other reasons. List of top 10 countries where patients travel to India for c1 c2 rotatory subluxation treatment and atlantoaxial dislocation treatment comes from: UK, Australia, USA, Kenya, Nigeria, Saudi Arabia, Sri Lanka, Uzbekistan, Afghanistan, Oman .

(Video) Atlanto Axial Dislocation | Dr. Komal Prasad C

Lecture on Minimally Invasive Spine Surgery at the meeting recently concluded by Artemis Gurugram Hospitals.

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(Video) C1-C2 (atlanto-axial) fixation for instability- Happy Patient Testimonial


What is the diagnosis and treatment of atlantoaxial subluxation? ›

Indications for treatment of atlantoaxial subluxation include pain, neurologic deficits, and potential spinal instability. Treatment includes symptomatic measures and cervical immobilization, usually beginning with a rigid cervical collar.

How is atlantoaxial subluxation diagnosed? ›

Atlantoaxial subluxation is usually diagnosed with plain neck x-rays. A neutral and forwarded flexed neck x-ray is best as it can demonstrate misalignment. A special radiographic measurement is used called the ADI (5).

How do you treat atlantoaxial subluxation? ›

Treatment of Atlantoaxial Subluxation

Treatment includes symptomatic measures and cervical immobilization, usually beginning with a rigid cervical collar. Urgency of treatment is generally based on symptoms or presence of cord abnormalities on MRI in susceptible patients.

How is atlantoaxial instability diagnosed? ›

Use of computed tomography (CT) can provide additional information regarding the stability of the atlantoaxial joint. Measuring displacement of defining rotation may be difficult on plain radiographs. Fine-cut CT with reformatting can be used for measuring the amount of displacement.

What is the treatment for atlantoaxial? ›

Treatment of Atlantoaxial Subluxation

Treatment includes symptomatic measures and cervical immobilization, usually beginning with a rigid cervical collar. Urgency of treatment is generally based on symptoms or presence of cord abnormalities on MRI in susceptible patients.

What is the diagnosis of subluxation? ›

During physical examinations, subluxation is detected by palpation of the glenohumeral joint. The extent of shoulder subluxation can be quantified by the distance from the acromion to the humeral head, using fingerbreadth, caliper, or tape.

How do you fix a subluxation in your neck? ›

Your chiropractor may perform adjustments to correct any subluxations, which involve gentle and usually painless thrusts that realign faulty joints and allow the body to heal. Combined with proper spinal care, this can prevent VSC from progressing into a more serious condition.

How do you treat a neck subluxation? ›

Treatment. If you suspect that you may have a spinal subluxation, the most recommended course of treatment is to visit a chiropractor. However, for minor cases relief can be achieved with stretches, over-the-counter pain medication, rest, and cold compresses.

Is neck subluxation serious? ›

Subluxation is an essential entity of traumatic subaxial cervical spinal injuries. There is a varying degree of slippage of the body of one vertebra relative to the adjacent vertebra, owing to ligamentous injury and the jumped facets, with, therefore, a high predisposition for injury to the spinal cord.

Who treats atlantoaxial instability? ›

Neurosurgeon or orthopedic spine surgeon.

What are the risks of atlantoaxial subluxation? ›

The most significant risk of atlantoaxial instability is neural compression which can present with the following complications:
  • Restricted neck movements.
  • Pyramidal signs and myelopathy.
  • Lower cranial nerve palsies.
  • Respiratory failure.
  • Vertebral artery dissection.
  • Quadriplegia.
  • Death[5]
Feb 14, 2023

How serious is atlantoaxial instability? ›

It has been reported that death is common in patients with RA once myelopathy develops in the patients with cervical spine involvement. Thirty-day mortality has been reported to be as high as 13% and 60% at 4 years in patients with advanced cervical disease.

Is subluxation serious? ›

Subluxations can lead to neurological conditions due to the pressure of the adjacent nerves. Subluxations over time will lead to negative affects on the discs, bones, and surrounding tissues. If left untreated for too long this damage becomes irreversible.

What are the signs and symptoms of atlantoaxial instability? ›

change in bowel or bladder control. neck pain or stiffness, or their head stays tilted. new weakness or they become fatigued more easily. a decrease in their activity level or function.

How do you fix C1 C2 instability? ›

Some common nonsurgical treatments for C1-C2 include:
  1. Medication. ...
  2. Immobilization. ...
  3. Physical therapy. ...
  4. Chiropractic manipulation. ...
  5. Injection of anti-inflammatory or pain reducing medications such as corticosteroids in the epidural space or the atlantoaxial joint at C1-C2.

What kind of doctor treats cervical instability? ›

If you have a craniocervical junction disorder, you may receive treatment from a neurologist, orthopedic surgeon, or neurosurgeon. In addition, physiatrists and pain management specialists, along with physical therapists and occupational therapists, can help reduce pain and improve your quality of life.

What is the other name for atlantoaxial subluxation? ›

Atlantoaxial instability (AAI), also known as atlantoaxial subluxation, is radiologically identified increased mobility or laxity between the body of the first cervical vertebra (atlas) and the odontoid process of the second cervical vertebra (axis) (see the image below).

Where is atlantoaxial subluxation seen? ›

Atlantoaxial subluxation is misalignment of the 1st and 2nd cervical vertebrae, which may occur only with neck flexion. . This disorder is very rare.

Does subluxation need surgery? ›

You might need surgery if you have repeated episodes of subluxation. Your surgeon can fix any problems that are making your shoulder joint unstable. This includes: ligament tears.

How long does subluxation take to heal? ›

Shoulder subluxation can take 12 to 16 weeks to fully heal.

A shoulder subluxation is a partial shoulder dislocation, which happens when the ball of the upper arm bone (the humerus) comes partially out of the shoulder socket.

How long does it take to fix a subluxation? ›

Although overall motion is probably not affected, chiropractic reconstructive care for a phase one subluxation can take from 6 to 18 months.

Can physical therapy fix subluxation? ›

Most commonly, subluxations are corrected easily with physical therapy treatment.

How do you fix a subluxation at home? ›

Rest is needed to help the joint heal. Ice and elevation can both reduce swelling and pain, but compression might actually make pain worse. After an initial trauma or injury, exercises to improve range of motion and strength can be incorporated under the care of a medical professional.

What is the medical treatment for subluxation? ›

Subluxation of the shoulder is treated with rest, ice packs and NSAID's to reduce the pain and inflammation. You may be referred to physical therapy for shoulder strengthening exercises to help prevent recurrence.

Can you fix subluxation on your own? ›

Your spine is able to reposition itself into its normal position again with no problem. However, not all subluxations are going to be minor, therefore not all subluxations will correct themselves over time through normal movement.

Can neck subluxation heal on its own? ›

Spinal subluxations can occasionally clear up on their own, but when they don't, chiropractic treatment should be sought out. A series of chiropractic adjustments can change the position and motion of the spinal bones so that they no longer impinge on adjacent nerves.

Does subluxation go away? ›

In general, mild subluxation may take a few weeks to heal with rest, physical therapy, and over-the-counter pain medication. A more severe subluxation may take several months to heal.

What happens if you don't treat a subluxation? ›

If you notice that you're struggling to regain full mobility in the joint, you should get an assessment right away. However, if subluxation happens more than once, it can cause damage to the ligaments—the strong connective tissues that stabilize joints—resulting in a recurrent injury and even chronic pain.

Can you live with a subluxation? ›

Both dislocations and subluxations can be painful, irritating, infuriating, and occasionally debilitating problems. However, they don't need to ruin your life and can — with patience, effort, trust, and time — be managed. Not necessarily completely eliminated, but managed.

What is stage 4 of subluxation? ›


In the final stage of the four phases of subluxation degeneration, quality and longevity of life in the patient is decreased. Bone and neurological damage are permanent at this point, as the vertebra become fused.

What happens when C1 and C2 are out of alignment? ›

If the C1 or C2 vertebra is out of place, they can be placing undue pressure on the brainstem, causing it to send improper signals to the brain. The brain may think the body is in motion when it is not actually moving, leading to the symptoms of vertigo.

What causes atlantoaxial subluxation? ›

The causes of atlantoaxial subluxation may be multifactorial, including transverse ligament damage by a periodontoidal proliferative pannus or sequelae of ossification of the anterior and posterior longitudinal ligaments, associated inflammatory lesions (cervical spine osteoarthritis, atlantodental synovitis, erosions ...

Can cervical neck instability be cured? ›

If you have cervical instability, you may be experiencing migraines, vertigo, or nausea. Fortunately, this condition is treatable, though not curable.

What are the negative effects of subluxation? ›

Effects of Subluxation
  • Physical Pain. A dislocated vertebra can lead to physical health problems such as pain, tenderness, and headaches.
  • Emotional Instability. In extreme cases, untreated subluxations can lead to emotional issues such as anxiety and depression.
  • Immune Deficiency. ...
  • Decreased Mental Capacity.

What is the mortality of atlantoaxial subluxation? ›

Nonunion rates have been reported to be up to 40% and mortality up to 35%, and poor functional outcomes are common.

Which syndrome is associated with atlantoaxial dislocation? ›

Congenital Causes

Certain congenital conditions are associated with craniocervical region abnormalities that predispose these populations to developing atlantoaxial dislocation. One particularly well-studied condition is Down syndrome.

Can MRI show cervical instability? ›

Special radiographic studies are required which include upper cervical MRI or rotatory CT scan. In addition, there are additional studies that involve the patient moving during the examination. These studies are useful to identify instability.

What is atlantoaxial dislocation in adults? ›

Adult acute atlantoaxial rotatory subluxation (AARS) is an uncommon, yet potentially life-threatening condition characterized by injury to the C1-C2 articulation with disruption of the facet joints and/or surrounding stabilizing ligaments including the alar and transverse ligaments (1).

Can a subluxation get worse? ›

As time goes on and the uncorrected subluxation settles, the damage to the nerve gets progressively worse different stages of subluxation degeneration set in. Regular visits to a licensed chiropractor can help to reduce the effects of subluxation and may be necessary maintain good health and physical fitness.

Should you go to ER for subluxation? ›

If possible, go to the emergency room instead of an urgent care or other clinic if you experience a dislocation. The ER is the best place to go because healthcare providers in the emergency room can get you any imaging tests and any medication you'll need before and after they put your joint back into alignment.

Which is more serious a dislocation or a subluxation? ›

A shoulder dislocation is more extreme than a shoulder subluxation. In this case, the ball and socket become completely separated.

What are the different types of atlantoaxial subluxation? ›

type I: the atlas is rotated on the odontoid with no anterior displacement. type II: the atlas is rotated on one lateral articular process with 3 to 5 mm of anterior displacement. type III: comprises rotation of the atlas on both lateral articular processes with anterior displacement greater than 5 mm.

Can a chiropractor fix C1? ›

A chiropractic doctor can treat conditions such as musculoskeletal pain, migraines, and sciatica with spinal adjustments. Upper cervical chiropractic is a subspecialty of chiropractic care that focuses on the 2 upper vertebrae of the spine: the atlas (C1) and the axis (C2).

What is the prognosis for atlantoaxial luxation? ›

The prognosis for atlantoaxial instability depends on the degree of spinal cord trauma and neurological deficits already present. Good for dogs with mild clinical signs and guarded for dogs with paralysis, but significant recovery is possible, if decompressed and stabilized.

How long does it take for a C2 vertebrae to heal? ›

These injuries take anywhere from eight to 12 weeks to heal.

How do you treat a subluxation in the neck? ›

Treatment. If you suspect that you may have a spinal subluxation, the most recommended course of treatment is to visit a chiropractor. However, for minor cases relief can be achieved with stretches, over-the-counter pain medication, rest, and cold compresses.

How is atlas subluxation diagnosed? ›

Your brain and nervous system control every cell, tissue and organ within your body. It is essential that this communication is undisturbed so optimal health can be achieved. Only a chiropractic examination can detect an ASC, and only a precise chiropractic adjustment can reduce their effect to your nervous system.

What is the treatment for vertebrae subluxation? ›

How is subluxation corrected? Chiropractors are specialists in correcting subluxation and other misalignments. A chiropractor can restore the misaligned vertebrae to their proper position in the spinal column. They do this manually by using the chiropractic procedure known as spinal adjustment.

What is the treatment for C5-C6 subluxation? ›

Anterior cervical discectomy and fusion (ACDF) surgery involves removing the C5-C6 intervertebral disc to relieve pressure on the spinal cord or C6 nerve root. The disc is replaced by an implant or bone graft, allowing biological fusion of the adjacent C5 and C6 vertebrae.

What is the best position to sleep in for cervical instability? ›

Sleeping on your back: This is the optimal sleeping position as it is the easiest to properly brace your head and position your neck. It is important, however, to find a pillow that reinforces the curvature of your neck, while using a flatter pillow to pad your head for comfort.

How do you fix C1 C2 subluxation? ›

Some common nonsurgical treatments for C1-C2 include:
  1. Medication. ...
  2. Immobilization. ...
  3. Physical therapy. ...
  4. Chiropractic manipulation. ...
  5. Injection of anti-inflammatory or pain reducing medications such as corticosteroids in the epidural space or the atlantoaxial joint at C1-C2.

How serious is a subluxation? ›

Is subluxation serious? A subluxated joint is less serious than a dislocated joint and typically easier to treat. Depending on the cause, manipulating the joint back into alignment may cause symptoms to resolve.

What is the recovery time for subluxation? ›

It usually takes up to 12 weeks to recover from a dislocated shoulder. It may take up to 16 weeks to fully return to playing some sports, but for some recovery can take longer. You'll need to wear a sling to support your arm for the first few weeks.

How long do subluxations take to heal? ›

In general, mild subluxation may take a few weeks to heal with rest, physical therapy, and over-the-counter pain medication. A more severe subluxation may take several months to heal.


1. Atlantoaxial instability- Types and treatment
(Neurosurgical TV)
2. MRI CV Junction - Atlanto axial subluxation / dislocation.
(MRI & CT Scan Tech)
3. Atlanto-axial instability - Professor Atul Goel
(Ganesalingam Narenthiran)
4. Post. intra-articular distraction w cage to treat congenital atlantoaxial dislocation w basilar ...
5. Dr.Guangyu Qiao: Treatment of Fixed Atlantoaxial Dislocation with Basilar Invagination
(Mehmet Zileli)
6. Central or axial atlantoaxial instability. Atul Goel
(Prof. Dr. Onur Yaman)


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