Atlanto-axial Subluxation Overview

In the atlanto-axial subluxation is a condition in which a particular joint is dislocated incomplete. In some cases, the disease is also referred to by medical professionals using the common abbreviation AASL. According to, the affected joint is usually the one located in the middle of the first and second vertebrae in the neck area. The cause of the atlanto-axial subluxation is usually an unstable structure of the joints. The atlanto-axial subluxation may damage the medulla of the back.

What is atlanto-axial subluxation?

In the context of the atlanto-axial subluxation, a special joint is not completely dislocated. The joint affected by the disease is located in the cervical spine. If the disease remains untreated or if it is treated too late or only inadequately, damage to the medulla of the back may result.

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


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

This deformity affects not only some people, but also certain dogs. These are mostly dog ​​breeds of small size. Sometimes the straps of the corresponding cervical vertebra are incorrectly formed, 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’s syndrome or Down syndrome. In addition, such complaints are more common in connection with Kniest’s dysplasia or the so-called Larsen syndrome. The atlanto-axial subluxation is triggered in some patients by a fracture of the dens axis.

A bony tear of the ligament is also a potential factor for the development of the subluxation. In addition, observations show that the atlanto-axial subluxation develops more frequently in connection with juvenile idiopathic arthritis or polyarthritis with a chronic course.

Symptoms, ailments & signs

The symptoms and signs of atlanto-axial subluxation are mainly based on how severely the medulla of the back has already been damaged by the disease. Many sick people experience pain in the neck area. These increase when patients bend their necks.

In addition, in some people the extremities are paralyzed, which is known in medical terms as tetraparesis. Sometimes the so-called proprioception is also impaired. In some cases the passage is significantly disturbed by the atlanto-axial subluxation. In this context, for example, the wobbler syndrome or ataxias occur.

In the context of the atlanto-axial subluxation that exists from birth, the typical symptoms of the disease usually develop in the first year after delivery. The situation is different with atlanto-axial subluxations as a result of trauma. In such cases, the symptoms of the disease appear acute and unexpected. Some of the patients suffer from complete paralysis of the extremities.

Diagnosis & course

When making the diagnosis, the symptoms of atlanto-axial subluxation and their visual representation play the most important role. A visit to a doctor is recommended for patients with the main symptoms of the disease in order to gain certainty about the symptoms of the disease and to initiate appropriate therapy. During the consultation with the patient, the attending physician tries to find out the causes of the disease.

Because atlanto-axial subluxation is congenital in some cases, the doctor will also take a family history. He then examines the patient clinically using various examination methods. First of all, 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 effects can also be clearly identified in this way.

In addition, some of the sick patients are also subjected to an MRI examination, which is also an imaging procedure. With the help of this examination, the extent of the impairment of the spinal cord can be assessed.


In most cases, the complications and symptoms of this disease depend heavily on the extent to which the back has already been damaged. Most of the time, however, there is severe pain in the neck when the patient bends over or stoops. It is not uncommon for the patient’s extremities to be paralyzed, so 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 locomotion 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 fully treat the congenital disease. If the restrictions have arisen as a result of trauma or an accident, therapies can be used that increase the mobility of the joint.

Surgical interventions can also be used here. However, if the paralysis affects the entire body, in many cases no cure is possible and the person concerned has to live with the symptoms his entire life.

When should you go to the doctor?

In the case of 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 usually manifests itself as pain in the back and neck. If this pain occurs over the long term and does not go away on its own, a visit to the doctor is definitely necessary.

The patient’s gait can also be restricted by the disease, resulting in gait problems or restricted mobility. If these symptoms occur, a doctor should also be consulted. The disease also leads to disorders of sensitivity or complete paralysis of the individual extremities.

In these extreme cases, too, a visit to the doctor is necessary. Usually the disease can 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 limitations throughout their lives.

Treatment & Therapy

Therapy of atlanto-axial subluxation is based on the individual symptoms of the patient. If there is only instability, then in many cases no therapeutic intervention is necessary. The damage to the medulla of the back is usually the decisive factor for or against a therapy. For example, a surgical procedure is possible, during which the joint is stabilized.

Patients who have suffered from atlanto-axial subluxation since birth usually have a relatively good prognosis. Compared to acquired subluxations, the symptoms are also rather mild. The prognosis is much 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 for freedom from symptoms are generally considered to be good. The later the therapy can start, the higher the risk of secondary diseases or permanent impairments.

If the cause of existing complaints is localized quickly, the prognosis is good. The not completely dislocated joint is straightened within a few minutes by a few professional movements by an orthopedic surgeon or chiropractor.

The organism then needs some time to heal and calm the nerve fibers before the patient is considered symptom-free. Delayed treatment can damage the spinal cord. 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 permanent healing. If there are other symptoms such as paralysis or trauma, the overall prognosis is somewhat less favorable. If the complaints were acquired in an accident, the chances of recovery depend on the total accident damage and injuries. There is a possibility that there will be lifelong impairments, as individual regions are no longer adequately supplied via the nerves or muscles.


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


As a rule, there are very few measures and options for follow-up care available to those affected by this disease. In the case of this disease, a quick diagnosis with subsequent treatment is primarily required, as this is the only way to avoid further complaints and complications. Self-healing cannot occur here either, so treatment must definitely be carried out.

The disease does not always have to be treated. The treatment depends on the exact severity of the complaints. 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 performed in your own home. This speeds up healing. Care and support from friends or family can have a positive effect on the further course of the disease and prevent other complaints. The disease does not have a negative impact on the life expectancy of the person affected. Further follow-up measures are not necessary.

You can do that yourself

With conservative treatment, the patient receives cortisone-free rheumatic drugs (NSAIDs) against the pain. With massages and physiotherapy, there are further options available to compensate for the pain. These therapies also serve to prevent the dislocation from progressing and to protect the spinal cord. The damaged joint complex on the neck is stabilized with a ruff.

Surgical intervention with osteosynthesis, in which the joints are stabilized with lag screws, cherry nails and cerclage, has proven to be 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 stresses the neck, grasping pliers can help to cope with everyday life as painlessly as possible.

With the ATLANTOtec® Atlas Correction Technique, there is now an alternative, massage-assisted procedure that has ensured good results for patients and gives them new hopes. The developers and users of this process consider a permanent solution to the problem without syringes and operations to be possible.

A specially developed massage, which is used specifically on the atlas, is intended to gradually smooth out the dislocations in the neck area and initiate the healing process. After the dislocation has been alleviated after a few months, the remaining bone deformity should be localized using the most modern image resolutions and addressed through a final adjustment.

Atlanto-axial Subluxation