Atlanto-Axial Subluxation – Causes, Symptoms & Treatment

Atlanto-axial subluxation

Atlanto-axial subluxation is a condition in which a specific joint is incompletely dislocated. In some cases, the disease is also referred to by the common abbreviation AASL by medical professionals. The affected joint is usually the one located in the middle of the first and second vertebrae in the neck area. The cause of atlanto-axial subluxation is usually an unstable structure of the joints. Atlanto-axial subluxation can damage the spinal cord.

What is Atlanto-Axial Subluxation?

In the context of atlanto-axial subluxation, a specific joint is not completely dislocated . The joint affected by the disease is located in the cervical spine. If the disease remains untreated or is treated too late or only insufficiently, damage to the spinal cord may occur.

For this reason, timely diagnosis of atlanto-axial subluxation is of particular importance. In the case of corresponding symptoms of the disease, a suitable specialist should be consulted so that adequate treatment can be initiated.


In principle, different factors are known to cause atlanto-axial subluxation. On the one hand, some of the affected patients have a deformity that is present from birth. As part of this anomaly, the so-called dens axis is not developed as in healthy people, but has an incomplete form. The dens axis is that cervical vertebra that is in second place.

Not only some people are affected by this deformity, but also certain dogs. These are mostly small breeds of dogs. Sometimes the ligaments of the corresponding cervical vertebra are malformed, so that an atlanto-axial subluxation develops. In some cases, the straps are too loose or even slack.

This is possible, for example, in connection with Marfan syndrome or Down syndrome . In addition, such complaints are more common in connection with Kniest dysplasia or the so-called Larsen syndrome. In some patients, atlanto-axial subluxation is caused by a fracture of the dens axis.

A bony avulsion of the ligament is also a potential factor in the development of the subluxation. Observations also show that atlanto-axial subluxation often develops in connection with juvenile idiopathic arthritis or polyarthritis with a chronic course.

Symptoms, Ailments & Signs

The symptoms and signs of atlanto-axial subluxation depend primarily on how badly the spinal cord has already been damaged by the disease. Many people with the disease experience pain in the neck area. These increase when patients bend their necks.

In addition, some people are paralyzed in their extremities, which is medically known as tetraparesis. Sometimes the so-called proprioception is also impaired. In some cases, the atlanto-axial subluxation significantly disrupts the gait. In this context, for example, the Wobbler syndrome or ataxia occur.

In the context of the atlanto-axial subluxation present from birth, the typical symptoms of the disease usually develop in the first year after delivery. The situation is different with atlanto-axial subluxations resulting from trauma . In such cases, the symptoms of the disease appear peracutely and unexpectedly. Some of the patients suffer from complete paralysis of the extremities.

Diagnosis & History

When making the diagnosis, the symptoms of the atlanto-axial subluxation and their visual representation play the most important role. Patients with the main symptoms of the disease are recommended to visit a doctor in order to gain certainty about the signs of the disease and to initiate appropriate therapy. During the consultation with the patient, the doctor treating you tries to find out the causes of the disease.

Since atlanto-axial subluxation is congenital in some cases, the doctor also takes a family history. He then examines the patient clinically using various examination methods. First, an X-ray examination is usually used to visualize the individual characteristics of the anomaly of the bone. As a rule, the consequences of traumatic influences are also clearly recognizable in this way.

In addition, an MRI examination is also carried out on some of the sick patients, which is also an imaging procedure. With the help of this examination, the severity of the impairment of the spinal cord can be estimated.


In most cases, the complications and discomfort of this disease depend heavily on how far the back has been damaged. Most of the time, however, severe pain in the neck occurs when the patient bends or bends over. It is not uncommon for the patient’s extremities to become paralyzed, with the result that the patient suffers from restricted mobility .

The quality of life is greatly reduced by the disease. In the worst case, this can lead to complete paralysis of all extremities, so that normal movement is no longer possible. The affected person is dependent on walking aids or the help of other people.

The treatment or therapy is causal. However, it is not possible to completely treat the congenital disease. If the limitations are caused by trauma or an accident, therapies that increase the mobility of the joint can be used.

Surgical interventions can also be used here. However, if the paralysis affects the entire body, in many cases healing is no longer possible and the person concerned has to live with the symptoms for the rest of their lives.

When should you go to the doctor?

With this disease, a doctor should always be consulted when the first symptoms appear. The earlier this disease is diagnosed, the more complications and consequential damage can be limited by appropriate treatment. The disease is usually manifested by pain in the back and neck. If this pain occurs over a long period of time and does not go away on its own, a visit to the doctor is definitely necessary.

The gait of the affected person can also be restricted by the disease, resulting in gait problems or restricted mobility. A doctor should also be consulted if these symptoms occur. The disease also leads to sensory disturbances or complete paralysis of the individual extremities.

Even in these extreme cases, a visit to the doctor is necessary. The disease can usually be diagnosed by a general practitioner. Further treatment is then carried out by therapists and other specialists. However, a completely positive course of the disease cannot be guaranteed in every case, so that patients may have to live with restrictions for the rest of their lives.

Treatment & Therapy

The therapy of the atlanto-axial subluxation takes place with regard to the individual symptoms of the patient. If there is only instability, in many cases no therapeutic intervention is necessary. The damage to the marrow of the back is usually the decisive factor for or against therapy. For example, an operation is possible to stabilize the joint.

Patients who have suffered from atlanto-axial subluxation since birth usually have a relatively good prognosis. The symptoms are also rather mild compared to acquired subluxations. The prognosis is far worse in cases in which the atlanto-axial subluxation has arisen as a result of traumatic effects and is associated with paralysis of the extremities.

Outlook & Forecast

The prognosis of an atlanto-axial subluxation depends on the time of diagnosis, a possible start of treatment and the existing cause. Nevertheless, the prospects of being free of symptoms are generally considered to be good. The later the therapy can begin, the higher the risk of secondary diseases or permanent impairments.

If the cause of the existing symptoms can be localized quickly, the prognosis is good. The incompletely dislocated joint is straightened within a few minutes by a few professional movements by an orthopedist or chiropractor .

The organism then needs some time to heal and calm down the nerve fibers before the patient is considered symptom-free. If treatment is delayed, damage to the spinal cord can occur. These are usually considered irreversible and must be treated in further therapies. In severe cases, surgery is necessary to restore the functionality of the skeletal system.

If a child is born with an atlanto-axial subluxation, there is also a good chance of a permanent cure. If other symptoms such as paralysis or trauma are present, the overall prognosis is somewhat less favourable. If the symptoms were acquired in an accident, the chances of recovery depend on the overall accident damage and injuries. There is a possibility of lifelong impairments, since individual regions are no longer adequately supplied with nerves or muscles.


Atlanto-axial subluxation can only be prevented in cases where the disease is not congenital.


Those affected with this disease usually have very few measures and options for aftercare. In the case of this disease, a quick diagnosis with subsequent treatment is primarily required, since this is the only way to avoid further symptoms and complications. Self-healing cannot occur here either, so treatment must be carried out in any case.

The disease does not always need to be treated. The treatment depends on the exact severity of the symptoms. However, regular checks and examinations should be carried out by a doctor in order to detect further damage. In severe cases, those affected are often dependent on physiotherapy measures.

Many of the exercises from such a therapy can also be carried out at home. This speeds up healing. The care and support of friends or family can have a positive effect on the further course of the disease and prevent other symptoms. The disease does not have a negative effect on the life expectancy of those affected. Further aftercare measures are not necessary.

You can do that yourself

In conservative treatment, the patient receives cortisone-free rheumatism drugs (NSAIDs) to relieve the pain. Massages and physiotherapy are other ways of compensating for the pain. These therapies also help prevent the dislocation from progressing and protect the spinal cord. The damaged joint complex on the neck is stabilized with a neck brace.

A surgical intervention with osteosynthesis measures in which the joints are stabilized with tension screws, Kirschner nails and cerclage has proven to be the most effective against the impairment. Such an intervention can provide significant relief and more freedom of movement, especially in the case of a congenital disease. Since bending over puts strain on the neck, gripping tongs can help to master everyday life as painlessly as possible.

With the ATLANTOtec® atlas correction technique, there is now an alternative, massage-assisted procedure that has brought good results to patients and gives new hope. The developers and users of this procedure believe that a permanent solution to the problem without injections and operations is possible.

A specially developed massage, which is used specifically on the atlas, is intended to gradually compensate for the dislocations in the neck area and start the healing process. After the dislocation has been alleviated after a few months, the remaining misaligned bones are to be localized using the latest image resolutions and then addressed with a final adjustment.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.