Technique for direct posterior reduction in irreducible atlantoaxial dislocation: Multi-planar realignment of C1–2

•C1-2 dislocation may occur in various planes.•Correction of dislocation in all planes is desirable.•The technique described uses long rod holder as lever and screw tulip as fulcrum.•Manipulation of the lever leads to realignment of C1 &C2.

ObjectiveApart from the commonly seen antero-posterior subluxation of C1 over C2, the dislocation may occur in vertical, lateral or rotational plane. Desired C1-2 realignment can be achieved by corrrecting its dislocation in all planes. We describe a technique for the same.Material and methodsThe clinical and radiological features of 16 patients (4 – traumatic and 12 – congenital) with irreducible atlantoaxial dislocation (AAD) admitted in the last 1.5 years were studied. Specific attention was paid to vertical dislocation with lateral and rotational components, apart from anterior–posterior subluxation. They were operated through direct posterior approach. The technique using a long rod holder as lever and screw head (tulip) as fulcrum was employed to achieve C1-2 realignment in all planes. The postoperative clinical and radiological data was analyzed and compared with preoperative data.ResultsPatients presented with progressive myelopathy and/or progressive worsening of neck pain. Vertical dislocation was seen in 11 patients with congenital AAD in addition to the antero-posterior subluxation seen in all. Three patients with traumatic AAD and 8 with congenital AAD had additional lateral dislocation or lateral tilt. Three patients with traumatic AAD and 7 with congenital AAD showed rotational component. Postoperatively, all patients showed clinical improvement.ConclusionsThe antero-posterior and vertical realignment could be achieved in all except one. Similarly, rotational and lateral components could be completely corrected in 8 out of 10 patients. The technique appears to realign the C1–2 in all planes and provides good anatomical restoration.