Rheumatoid backward dislocation of the atlas with compression of the spinal cord

A 61-year-old man suffered a rheumatoid destruction of the dens of the C-2 vertebra with subsequent backward dislocation of the atlas resulting in tetraparesis. The clinical picture was consistent with a central spinal cord syndrome with motor impairment more of the upper than of the lower extremities. Reduction of the dislocation with skull traction followed by a posterior fixation from the occiput to C-3 resulted in a marked neurological restitution.