[History, current status and future of the treatment for irreducible atlantoaxial dislocation]

Irreducible atlantoaxial dislocation (IAAD) refers to a pathological condition characterized by instability and difficulty in achieving reduction through traction, resulting from abnormalities in the bony or soft tissue structures around the atlantoaxial joint. Previous treatments primarily focused on palliative decompression, which often led to suboptimal outcomes. As the understanding of its pathology has evolved, reduction and fixation have emerged as core principles: adequate decompression is achieved through sufficient soft tissue release to enable reduction, followed by fixation and fusion. Anterior decompression combined with rigid internal fixation is indicated only when reduction is unattainable. Over the past two decades, release techniques and related concepts have continuously advanced. The combined anterior-posterior approach, transoral stepwise release technique (TSRT), and posterior facet distraction and fusion technique (PFDF) have been successively developed, each with its own specific focus. Currently, posterior techniques can address most cases; however, complex scenarios still require transoral release technology. In the future, diagnostic and therapeutic decision-making based on big data and artificial intelligence, along with the application of augmented reality technology, will represent new research directions in IAAD treatment.