The commonly accepted mechanism of rheumatoid C1—C2 dislocation is the incompetence of the transverse ligament of C1 vertebra. The presence of rheumatoid granulation tissue between the anterior arch of C1 vertebra and the odontoid process is an important factor. This might explain why the dislocation becomes irreducible when the disease progresses. In a 55 year old man, transoral removal of the rheumatoid granulation tissue made the previously irreducible C1—C2 dislocation reducible. Stabilization of the reduced C1—C2 articulation was accomplished at a second operation by posterior fusion of the occiput to C1, C2, and C3 vertebrae.
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