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Atlantoaxial Instability/C1-2 Disorders

Atlantoaxial Instability/C1-2 Disorders
Atlantoaxial Instability/C1-2 Disorders

Washington University spinal neurosurgeons are national experts in the treatment of instability of the top of the cervical spine, between the first and second cervical vertebrae (C1 and C2).

Our surgeons provide a full range of treatment options including non-surgical options as well as surgical repair, and are internationally recognized for developing innovative techniques used to treat C1 and C2 disorders. 

Conditions & Treatments

The atlantoaxial complex refers to the first two bones of the neck (C1, the atlas, and C2, the axis) as well as the associated collection of ligaments that connect the bones together and the blood vessels that travel through them to the brain.

Although most of the bones of the spine are fairly uniform in their shape and function, the atlas and axis are unique, both in appearance and function. 

The atlantoaxial complex is primarily responsible for enabling the head to rotate, or turn to the left and right, while also protecting the spinal cord from injury. Because of its role in movement, it is, unfortunately, commonly injured. The bones are susceptible to fracture from high-energy impact such as falls or car accidents, especially in the elderly. The ligaments that hold the bones together also can be injured in trauma, or weakened in certain inflammatory conditions such as rheumatoid arthritis or Down’s syndrome. When the bones or ligaments of the atlantoaxial complex are injured, the spinal cord is at particular risk for injury, and surgical treatment is often indicated. Surgery is often challenging because of the shape of the C1 and C2 bones, and because the vertebral arteries pass in and around these two bones on the way to the brain. 

Spinal neurosurgeons at Washington University have extensive experience in treating these disorders, and receive many referrals of patients with these problems from other spine surgeons in the region.  One of the common surgical techniques used for treating atlantoaxial instability (C2 translaminar screws) was developed in the Department of Neurosurgery in 2003 and is now popular worldwide.  

Our surgeons can discuss with you the various treatment options for your specific condition.



Washington University neurosurgeons pioneered one of the most common methods of treatment for Atlanto-axial disorder.