Current trends in management of atlantoaxial dislocation. Atlantoaxial rotatory subluxation aars refers to a number of pathologic processes in which increased rotational instability of the c12 joint causes disarticulation of the facets and translational subluxation. Posterior atlantoaxial fusion using a c2 transverse. Neurologic sequelae secondary to atlantoaxial instability. Pathogenesis of nontraumatic atlantoaxial subluxation. Atlantoaxial subluxation radiology reference article. Describe a treatment approach to nontraumatic atlantoaxial subluxation in children 4. Also known as rotatory dislocation, displacement, or fixation important to differentiate from congenital muscular torticollis vast majority can be managed with nonoperative treatment by observation or traction description. Anterior subluxation occurs in up to 35%, followed by vertical subluxation in 22. In a cohort of 55 rheumatoid cervical patients who. Some mr imaging findings other than abnormal adi relate to aaa subluxation. Nontraumatic atlantoaxial subluxation in an adult due to retropharyngeal abscess has been only sporadically reported.
Original research revisiting anterior atlantoaxial subluxation with overlooked information on mr images s. Atlantoaxial instability, veterinary clinics of north. Atlantoaxial subluxation in children remains incompletely understood despite its relatively frequent appearance. Normally, this atlantodental distance is less than 2 mm, sometimes a maximum of 3 mm is accepted in men and 2. It is sometimes called rotary subluxation or atlantoaxial rotary subluxation. Find powerpoint presentations and slides using the power of, find free presentations research about atlantoaxial subluxation ppt.
However, at the end of two weeks, she returned with torticollis despite wearing the cervical collar. This lesion, untreated, may result in damage to the spinal cord, paresis or sudden death. The anterior facet of c1 is fixed on the facet of c2. Some of the events to be considered at the time of the. A thorough cervical spine examination is warranted for patients presenting with the following conditions. I is characteristic of rheumatoid arthritis ra that. Atlantoaxial rotatory subluxation, transverse ligament injury. Neurologic sequelae secondary to atlantoaxial instability in down syndrome. Atlantoaxial subluxation definition of atlantoaxial. A diagnosis was not made until 2 months after the occurrence of infection. Congenital anomaly of the atlas misdiagnosed as posterior arch fracture of. In this lesson, learn about the definition and causes of atlantoaxial subluxation.
Atlantoaxial subluxation in an ankylosing spondylitis patient with cervical spine ossification. If patients present with neck pain and torticollis, it could be a manifestation of atlantoaxial rotatory subluxlation. Subluxation of the atlantoaxial joint occurs when the normal alignment of the first and second vertebrae in the neck is disrupted. Nondisplaced fracture or dislocation of atlantoaxial joint results in severe pain, numbness and weakness in upper extremities. She was again treated with gardnerwells traction for two weeks followed by cervical collar for three months. Spinal mri sagittal t1 weighted images a and sagittal t2 weighted images b. In this lesson, learn about the symptoms and treatment for this type of injury. Atlantoaxial instability, veterinary clinics of north america. Mar 30, 2016 i drank celery juice for 7 days and this is what happened no juicer required. This results in excessive movement of this joint instability which can cause neck pain and pressure on the nerves of the spinal cord which runs through the tunnel vertebral canal created by the vertebrae. The adi is the imaging diagnostic clue to aaa subluxation of the cervical spine.
Direct url citations appear in the printed text and are provided in the html and pdf versions of this article on the journals. Atlantoaxial subluxation is a disorder of c1c2 causing impairment in rotation of the neck. Ninetytwo patients 57% had upper cervical involvement, which progressed into anterior atlantoaxial subluxation, vertical subluxation, and both. Atlantoaxial subluxation in different intraoperative head positions in patients with rheumatoid arthritis you will receive an email whenever this article is corrected, updated, or cited in the literature. Sturges, davis, california atlantoaxial aa instability with subluxation of c2 relative to c1 is a frequent cause of cervical pain as well as myelopathy in toy and miniature breeds of dogs. Management consisted of analgesia, sedation, and application of a halo skull traction device. It is an underdiagnosed condition that must be taken into account in the initial assessment of all craniocervical trauma.
Pitfalls in the ct diagnosis of atlantoaxial rotary. Occipital headache, present in of 22 patients, was often aggravated by working with the head in forward flexion. Nov 21, 2018 atlantoaxial instability aai is characterized by excessive movement at the junction between the atlas c1 and axis c2 as a result of either a bony or ligamentous abnormality. Atlantoaxial rotatory subluxation is rarely caused by trauma in adults. Pdf on jan 1, 2017, mishra dk and others published atlantoaxial subluxation of the cervical spine as the initial presentation of rheumatoid. Pitfalls in the ct diagnosis of atlantoaxial rotary subluxation. Nontraumatic atlantoaxial subluxation in an adult secondary. Atlantoaxial subluxation is known to occur as a complication of an adenoidectomy, especially after a trau matic operation. Vertical atlantoaxial subluxation, measurement methods openi. Atlantoaxial dislocation refers to a loss of stability between the atlas and axis c1c2, resulting in loss of normal articulation fig. Mar 01, 2016 key points atlantoaxial instability is a congenital condition affecting toy breed dogs. Usually, the treatment of choice is traction using halogardnerwells fixation devices for up to six weeks.
The transverse ligament is the primary restraint against atlantoaxial, anteroposterior movement. Aars is relatively rare in adults but somewhat more common in children, albeit by a largely different mechanism of action. Jul 18, 2016 diagnosis and treatment of atlantoaxial subluxation beverly k. Pdf iatrogenic atlantoaxial rotatory subluxation after. The uppermost cervical vertebra the atlas rotates about the odontoid process of the second cervical vertebra the axis.
The greatest potential for excess movement of one vertebra on its neighbour and possible misalignment is right at the top of the spinal column, at the atlantoaxial. Pitfalls in the ct diagnosis of atlantoaxial rotary subluxation 697 ct was used to examine six patients with clinically evident atlantoaxial rotary fixation, two patients with torticollis, and six normal subjects who had turned their heads to the side as far as voluntarily possible. One of the causes of death in rheumatoid patients is cord compression following atlantoaxial subluxation. Surgical treatment of c1c2 subluxation has evolved significantly over the past 2 decades, from the relatively simpler posterior wiring to more technically demanding instrumentations such as c1 lateral mass screws c2 pedicle screws, c1c2 transarticular screws, and occipital cervical fusion. Atlantoaxial dislocation aad which often arises from trauma, tumors or congenital malformations in the upper cervical region, is a challenging disorder of the.
Undiagnosed atlas subluxation in patient with pain and poor myofascial function. Key points atlantoaxial instability is a congenital condition affecting toy breed dogs. Study guide acute atlantoaxial rotary subluxation aars key points. These vertebrae form the atlantoaxial aa joint, which is connected by ligaments. Atlantoaxial subluxation in an ankylosing spondylitis. When dislocation or instability occurs, it may be mild to serious and caused by many different factors. It may be associated with dislocation of the lateral mass of c1 on c2. Synovial thickening exerted an anterior mark on the bulbomedullary junction with no evidence of oedema signs.
Rheumatoid arthritis, atlantoaxial subluxation, cervical spine, rehabilitation, treatment. The atlantoaxial joints can lose stable articulation from traumatic, inflammatory, idiopathic, or congenital abnormalities. The definite treatment strategy of traumatic c12 rotatory dislocation or subluxation with c2 fracture, especially dens fracture, has not been established because this combined c12 complex injury. Atlantoaxial rotational fixation aarf is a rare entity in adults, with only a few cases reported in the english literature and often associated with a traumatic mechanism. Fielding and hawkins described four types in 1977, almost all cases seen clinically are types i or ii, in which the displacement is not severe. Subluxation is another term for dislocation, and atlantoaxial references the top two cervical vertebrae. The clinical picture, radiological findings and treatment of 22 patients with atlantoaxial subluxation and rheumatoid arthritis are described. Atlantoaxial subluxation aas is a disorder of c1c2 causing impairment of stability. Atlantoaxial instability aai is characterized by excessive movement at the junction between the atlas c1 and axis c2 as a result of either a bony or ligamentous abnormality. It is also known under the eponym of grisels syndrome gs. We present the case of a 19yearold caucasian woman with traumatic atlantoaxial subluxation. Both diagnostic and therapeutic delay may be a potential cause of severe neurological. Discuss the spectrum of severity of atlantoaxial subluxation in children 2.
The first and second vertebrae in the neck are called the atlas and the axis, respectively. Six skeletally immature patients with fielding type iii atlantoaxial rotatory subluxation were treated conservatively with or without. I drank celery juice for 7 days and this is what happened no juicer required. Alternatively, you can also download the pdf file directly to your computer, from where it can be opened using a pdf reader. Rheumatoid arthritisatlantoaxial subluxation and its. In 7 of these 10 patients vertical subluxation of the atlas was responsible for the neural deficit. The surgical treatment principles of atlantoaxial instability. Nov 21, 2018 for patients with genetic or metabolic syndromes with higher rates of aai or atlantoaxial subluxation aas as compared with a normal population, there are multiple additional details that are relevant to the clinician. Diagnosis and treatment of atlantoaxial subluxation beverly k. Diagnosis and treatment of atlantoaxial subluxation. Atlantoaxial rotatory subluxation a rare complication of craniofacial surgery. Revisiting anterior atlantoaxial subluxation with overlooked information on mr images s. Thirteen patients with aai, including 5 ra patients, received preoperative computed tomography ct based imageguided navigation system igs in c1 lateral massc2 pedicle screwrod system fixation lc1pc2 fixation.
Radiographic findings consistent with atlantoaxial subluxation include dorsal displacement of the axis into the. Nontraumatic atlantoaxial subluxation aas is an uncommon complication of upper neck inflammatory processes and head and neck surgery. The aim was to report a rare case of isolated traumatic atlantoaxial rotatory subluxation without ligamentous injury. Because of this, people can strike the steering wheel or dashboard with their head at extreme forces, potentially leading to atlantoaxial subluxation.
The left anterior facet of c1 is fixed on the facet of c2, with anterior displacement of the right anterior facet. Case report of a traumatic atlantoaxial rotatory subluxation. By continuing to use our website, you are agreeing to our use of cookies. Atlantoaxial subluxation refers to a condition affecting the top of the spine. Anterior atlantoaxial subluxation with down syndrome and. Jan 23, 2012 atlantoaxial rotatory subluxation is rarely caused by trauma in adults. Pdf atlantoaxial subluxation of the cervical spine as the initial. Also known as rotatory dislocation, displacement, or fixation important to differentiate from congenital muscular torticollis vast majority can be managed with nonoperative treatment by observation or traction. Learning radiology atlantoaxial subluxation, dislocation. Atlantoaxial subluxation in different intraoperative head. This is a pdf file of an article that has undergone.
Generally,theoriginofatlantoaxial dislocations can be divided into three. Discuss imaging of atlantoaxial subluxation in children. Pertaining to the first and second cervical vertebrae which meet at a joint called the atlantoaxial joint. Undiagnosed atlas subluxation in patient with pain and. A widening of the atlantoaxial joint, as measured between the posterior surface of the anterior arch of atlas and the front of the odontoid process, indicates an injury to the transverse atlantal ligament. Although the screw was placed in the same direction as a standard atlantoaxial transarticular screw, a lateral entry point was utilized to penetrate the transverse foramen. Neurologic sequelae secondary to atlantoaxial instability in.
Navigation with fluoroscopy is currently the standard of practice in most centers. Dislocations in the cervical spine are common with patients who have rheumatoid arthritis. This paper presents a case of posttraumatic atlantoaxial dislo cation, which showed no. The discovertebral joints in the cervical spine may be affected in patients with rheumatoid arthritis ra with resulting osteochondral destruction. Know the causes, symptoms, diagnosis, treatment, prognosis. To download the pdf, click the download link below.
Subsequent to c1 laminectomy, a right atlantoaxial transarticular screw was inserted, aided by neuronavigation using a unique trajectory through the c2 transverse foramen. Atlantoaxial subluxation in dogs basic information description the spine is made up of small bones called vertebrae, which surround and protect the spinal cord. Apr 08, 2020 atlantoaxial subluxation refers to a condition affecting the top of the spine. Vertical atlantoaxial subluxation, measurement methods. Posterior atlantoaxial fusion using a c2 transverse foramen. Acute atlantoaxial rotary subluxation aars key points. After removing halo skull traction, full reduction and recovery were achieved without instability. Atlantoaxial instability is defined by an increase in the predentate space of greater then 3 mm in adults and 5 mm in children. View and download powerpoint presentations on atlantoaxial subluxation ppt. Orthopedics an upper cervical spine subluxation which is either rotatory or anterior. Traumatic atlantoaxial rotatory subluxation in an adolescent.
Cervical subluxation in rheumatoid arthritis uptodate. Craniocervical junction abnormalities with atlantoaxial subluxation. A team of medical professionals published two different case reports where individuals sustained these serious injuries in auto accidents. Although any dog could develop atlantoaxial subluxation due to trauma for example, running into a patio door, it is most commonly seen in toy breeds of dogs, such as yorkshire terriers or poodles. E toussirot, a benmansour, j f bonneville, d wendling. All children with down syndrome who wish to participate in sports should have cervical spine xrays. The joint between the axis and atlas is a pivot type of joint that allows the head turn. Atlantoaxial instability screening information sheet. Atlantoaxial instability occurs in 10% to 20% of patients with down syndrome who are at risk for atlantoaxial subluxation and subsequent complications during anesthetic induction and during positioning and manipulation associated with surgery. Define grisels syndrome, and discuss the pathophysiology of this condition 3. The pdf file you selected should load here if your web browser has a pdf reader plugin installed for example, a recent version of adobe acrobat reader.
Early reduction three hours after trauma and immobilization using only a soft collar were performed and yielded very good. Traumatic atlantoaxial rotatory fixation in an adult. Acute atlantoaxial rotary subluxation aars pediatric. When the distance on xray between the atlas 1st vertebra and odontoid process 2nd vertebra is more than. We present a case report of a 6yearold boy with gs that resulted from a retropharyngeal abscess. We report a case of an 8yearold female with atlantoaxial rotatory subluxation aars secondary to aggressive cervical manipulation as a traditional cure for asthma. Neurologic symptoms can occur when the spinal cord or adjacent nerve roots are involved. Atlantoaxial rotatory subluxation classification classification rotatory subluxation is classifed into four types depending upon the degree of separation of the dens from the anterior arch of atlas. Atlantoaxial rotary subluxation after minor trauma. Atlantoaxial subluxation is a condition where the vertebra in the neck become slightly dislocated or misaligned.
532 863 750 896 110 143 673 981 172 189 417 731 49 550 343 1393 1067 1261 803 101 756 626 523 501 1475 1192 711 590 914 1156 1034 361 520 1163 251 979 948 1317 1276 1498 531