The atlantoaxial joint C2 (axis) with the anterior arch of C1 (atlas) allows 50% of cervical lateral rotation. It is responsible for precise and important movements that allow us to perform precise actions, both in normal and working life. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed and the outcome is worse. An early diagnosis and treatment are essential to ensure satisfactory neurological and functional outcomes. The aim of this review is to analyze C1-C2 rotatory subluxation in adults, given its rarity. The time between injury and reduction is key, as it is directly related to prognosis and the severity of the treatment options. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed as a lot of cases are not related to a clear trauma, with a poor prognosis just because of the late diagnosis and the outcome is worse. The correct approach and treatment of atlantoaxial dislocation requires a careful study of the radiological findings to decide the direction and plane of the dislocation, and the search for associated skeletal anomalies.

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We present the case of a patient with a locally advanced synovial sarcoma treated with neoadjuvant chemotherapy and subsequent surgery who presented an early metastatic relapse, wherein a rapid and significant response was achieved with trabectedin, and in whom maintenance of the drug until clinical progression of the disease allowed 27 cycles of treatment to be administered despite the patient presenting radiological progression according to Response Evaluation Criteria In Solid Tumors (RECIST) criteria 15 cycles earlier.