(See also Evaluation of Neck and Back Pain Evaluation of Neck and Back Pain Neck pain and back pain are among the most common reasons for physician visits. This discussion covers neck pain involving the posterior neck (not pain limited to the anterior neck) and low... read more and Craniocervical Junction Abnormalities Craniocervical Junction Abnormalities Craniocervical junction abnormalities are congenital or acquired abnormalities of the occipital bone, foramen magnum, or first two cervical vertebrae that decrease the space for the lower brain... read more 
.)
Atlantoaxial subluxation can result from major trauma or can occur without trauma in patients with rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is a chronic systemic autoimmune disease that primarily involves the joints. Rheumatoid arthritis causes damage mediated by cytokines, chemokines, and metalloproteases.... read more 
, juvenile idiopathic arthritis Juvenile Idiopathic Arthritis (JIA) Juvenile idiopathic arthritis is a group of rheumatic diseases that begins by age 16. Arthritis, fever, rash, adenopathy, splenomegaly, and iridocyclitis are typical of some forms. Diagnosis... read more 
, or ankylosing spondylitis Ankylosing Spondylitis Ankylosing spondylitis is the prototypical spondyloarthropathy and a systemic disorder characterized by inflammation of the axial skeleton, large peripheral joints, and digits; nocturnal back... read more 
. This disorder is very rare.
Atlantoaxial subluxation is usually asymptomatic but may cause vague neck pain, occipital headache, or occasionally intermittent (and potentially fatal) cervical spinal cord compression.
Diagnosis of Atlantoaxial Subluxation
Plain x-rays
MRI to assess the integrity of the ligaments
Atlantoaxial subluxation is usually diagnosed with plain cervical x-rays; however, flexion views may be required to show intermittent subluxation. Views during flexion, as tolerated by the patient, show dynamic instability of the entire cervical spine. If x-rays are abnormal or if they are normal but subluxation is still suspected, MRI, which is more sensitive, should be done. MRI also provides the most sensitive evaluation of spinal cord compression Diagnosis Various lesions can compress the spinal cord, causing segmental sensory, motor, reflex, and sphincter deficits. Diagnosis is by MRI. Treatment is directed at relieving compression. (See also... read more 
and is done immediately if cord compression is suspected.
Treatment of Atlantoaxial Subluxation
Treatment of symptoms
Cervical immobilization
Surgery
Indications for treatment of atlantoaxial subluxation include pain, neurologic deficits, and potential spinal instability. Treatment includes symptomatic measures and cervical immobilization, usually beginning with a rigid cervical collar. Urgency of treatment is generally based on symptoms or presence of cord abnormalities on MRI in susceptible patients. In cases where symptoms increase or in acute traumatic injuries, surgery may be needed to stabilize the spine.
