An otherwise healthy 30-year-old male self-presented to the emergency department after being involved in a low-speed traffic collision. He was seeking evaluation of acutely worsening neck pain that had been present for approximately 1 year. Physical examination demonstrated a fixed leftward gaze with midline tenderness about the cervical spine. There were no neurological deficits. He noted to our team that his gaze had been fixed and his neck had been painful for 1 year following a work-related accident. Computed tomography (CT) scan demonstrated a Fielding Type 1 AARS of approximately 45° (). A cervical spine X-ray from 4 months prior was obtained that also demonstrated subluxation of the atlantoaxial joint (). He was subsequently admitted and placed into 20 pounds of cervical traction with Gardner-Wells tongs. He was also started on oral benzodiazepines for muscle relaxation. Post-traction X-rays demonstrated reduction of the chronic subluxation (). The patient was maintained in cervical traction for 48 h and was then taken to the operating room where posterior C1–C2 instrumentation and fusion were performed undermaintained traction. There were no complications related to the procedure. Post-operative CT and X-rays demonstrated maintained reduction and alignment of the atlantoaxial joint (). The patient regained normal head alignment and had relief from his pre-operative symptoms. He was discharged home from the hospital on post-operative day #6.