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Figure 5: Type IV dislocation, defined as translational and rotational dislocation with coronal tilt but without basilar invagination. Bilateral asymmetrical facet joints (one side vertical and another side oblique) cannot allow the smooth reduction of AAD by C1–C2 distraction with spacer, rather atlantodental interval and rotation may increase during distraction due to spacer application between this asymmetrical joint. The neurological deficit may worsen due to a reduction in critical diameter

Figure 5: <i>Type IV</i> dislocation, defined as translational and rotational dislocation with coronal tilt but without basilar invagination. Bilateral asymmetrical facet joints (one side vertical and another side oblique) cannot allow the smooth reduction of AAD by C1–C2 distraction with spacer, rather atlantodental interval and rotation may increase during distraction due to spacer application between this asymmetrical joint. The neurological deficit may worsen due to a reduction in critical diameter