The diagnosis and treatment procedure of refractory atlantoaxial dislocation About the concept of refractory atlantoaxial dislocation: There is no unified standard for the diagnosis of atlantoaxial dislocation. Some authors consider it as a refractory dislocation when the preoperative cranial traction is 3-6 kg for 2 weeks, the atlanto-anterior space (ADI) is greater than 5 mm or under general anesthesia, and the large dose can reach 10 kg for 10 minutes and still cannot be completely dislocated. About treatment: Based on the above non-uniform diagnostic criteria, the choice of treatment modality is more based on some of our own experience, such as direct posterior repositioning and fixation; direct resection and decompression of the dentition through the oral cavity; posterior repositioning and fixation with anterior release (and oral and submaxillary); direct anterior repositioning and fixation after oral release and posterior release and fixation through the atlantoaxial joint. Our treatment strategy: Our management of such patients is to routinely preoperative neutral or hyperextension cranial traction, traction weight from 3-kg gradually increased to 6-8 kg (according to the patient’s weight and tolerance, the amount can be reduced at night), general traction for about 1 week, observe the changes in the atlantoaxial joint, if the reset is greater than 30%, it is estimated that the possibility of simple posterior repositioning and fixation, then general anesthesia If the majority of the atlantoaxial joint is repositioned, we use a simple posterior approach with the application of a nail bar to achieve nearly complete repositioning. If the repositioning is less than 50% with high-dose cranial traction under anesthesia, we use a submaxillary approach to release the muscles, scar and joint capsule in front of C1.2, and pry the atlantoaxial joint through a curved prying device during surgery. In some patients with posterior arch deficiency, we attempted fusion through submaxillary approach after release and direct submaxillary release and fixation.