Fig. 3.

A schematic representation of the traction technique involving three stages to reposition the joint. In the initial distraction phase (A), the patient is placed in slight flexion to keep the ring of C1 opposed to the posterior odontoid and to avoid hitting the spinal cord as traction weight is gradually added. After full distraction, the realignment phase (B) will occur when C1 slips back over the odontoid. Excessive flexion during distraction could cause the ring to slip too far forward. The release phase (C) consists of switching to an extension posture and slowly releasing traction over several hours with gradual weight reduction. Note the gradual realignment of the occiput to the cervical spine, as denoted by the decreasing atlantodental interval (black arrows).