Address the cause, not the effect: C1-2 joint manipulation and not odontoidectomy in congenital atlantoaxial dislocation and basilar invagination

Abstract

The C1-2 joints in cases of congenital atlantoaxial dislocation are often oblique in both sagittal and coronal planes giving rise to anteroposterior and vertical slip of C1 over C2. Asymmetry on either side gives rise to coronal/lateral angular tilt along with rotational component. The dislocation is a dynamic process though it may appear to be fixed. The compressing dens is effect of dislocation and not the cause. The treatment should be directed towards C1-2 joint manipulation that would realign the joints as well as the dens. The facetal osteotomies coupled with manipulation for realignment in all planes provides a composite solution for even the complex lateral dislocation or complete spondyloptosis with severely deformed C1–2 joints, obviating the need for transoral decompression.