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Here, we divided irreducible AAD into two categories: a) reducible-utilizing a thumb maneuver to compress/push the C2 spinous process forward with the patient positioned prone and b) irreducible-those who cannot be reduced with this technique. A posterior only approach was sufficient for those with "reducible" AAD, whereas those who could not be reduced required an anterior release followed by posterior fusion.

Use of intraoperative X-ray to differentiate between reducible versus irreducible atlantoaxial dislocation