Traumatic atlantoaxial dislocation without fracture of the odontoid

Four cases of atlantoaxial dislocation without fracture of the odontoid have now been reported in patients surviving significant trauma. Experience with these cases suggest the following: 1. Atlantoaxial dislocation is compatible with survival and minimal or no long-term neurologic effects. 2. Reduction of the dislocation by traction is possible and has not resulted in significant complications, but marked instability can be present. Close medical supervision and frequent radiographic evaluation is mandatory. During reduction, the weight and angle of traction applied is changed in each phase of reduction (distraction, realignment, release). After reduction, physician-controlled, gentle flexion-extension radiographs are used to assess stability. 3. Traction should be started with light weights, care being taken to avoid overdistraction. A maximum of 15 lb traction was required for reduction in the present case. 4. Posterior surgical fusion is usually necessary because of residual instability and/or incomplete reduction, as demonstrated by postreduction supervised, gentle flexion-extension radiographs and/or CT scan. 5. There may be a small number of patients who can be treated by immobilization alone if a completely stable, anatomic reduction is obtained with traction.