Occipital plate-assisted posterior reduction for tumor-related severe atlantoaxial dislocation: a single-case...

Tumor-related severe atlantoaxial dislocation is rare but may rapidly endanger the cervicomedullary junction when axis destruction, pathological fracture, and craniovertebral instability coexist. This single-case technical note describes a posterior-only occipital plate-assisted reduction technique for a selected patient with severe but reducible tumor-related atlantoaxial dislocation in whom the atlas and axis could not be used as reliable reduction anchors. Conventional reduction strategies for congenital, inflammatory, traumatic, or degenerative atlantoaxial dislocation commonly depend on traction, atlantoaxial joint release, direct C1-C2 manipulation, or C1/C2 screw-based reduction. These maneuvers may be unsafe when the atlas has translated anteriorly beyond the axis body or when osteolysis structurally compromises the axis. The operative principle is to use the occipital plate as an active proximal reduction handle and the subaxial cervical spine as a reliable distal fixation base. After neutral Mayfield positioning, posterior exposure, decompression when indicated, and distal cervical screw placement, a precontoured rod is locked to the distal anchors. The occipital plate is connected to the proximal rod while maintaining a deliberate plate-to-skull step-off. The plate is then compressed to the occipital surface and fixed with occipital screws; release of compression allows the skull-occiput complex to settle into the rod-defined alignment, indirectly reducing the atlantoaxial dislocation without lifting the tumor-involved C1-C2 segment. The illustrative case demonstrates immediate radiographic correction and decompression through a single posterior approach, with quantitative radiographic and clinical outcomes reported in tabular form. As the evidence is limited to one patient, the technique should be considered hypothesis-generating and requires larger clinical series and biomechanical validation before broader adoption.