All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Atlanto-axial subluxation (C1-C2 subluxation) and back pain
Medical expert of the article
Last reviewed: 08.07.2025
Atlantoaxial subluxation is a dislocation between the first and second cervical vertebrae that can only occur when the neck is flexed.
Atlantoaxial subluxation may result from severe trauma such as high-velocity deceleration, but may also occur without trauma in patients with rheumatoid arthritis, juvenile rheumatoid arthritis, or ankylosing spondylitis. Atlantoaxial subluxation is usually asymptomatic but may cause vague neck pain, occipital headache, and, less commonly, intermittent (potentially fatal) cervical spinal compression.
Atlantoaxial subluxation is diagnosed by radiographs, but radiography may not reveal the entire cervical spine unless a flexion study is performed. Flexion performed by the patient reveals dynamic instability of the entire cervical spine. If radiographs are normal and subluxation is highly suspected, MRI, which has greater sensitivity than radiography, should be performed. MRI also allows the diagnosis of spinal cord compression and should be performed immediately if spinal cord compression is suspected. Indications for treatment include pain, neurologic deficits, and possible instability of the vertebrae. Treatment includes symptomatic measures and cervical immobilization, usually with a rigid cervical collar. Surgery may be required to stabilize the vertebrae.
[