Atlantoaxial subluxation is a disorder of c1c2 causing impairment in rotation of the neck. It may be associated with dislocation of the lateral mass of c1 on c2. Hence, a case about coexisting odontoid subluxation syringomyelia and vertebral artery abnormalities is reported here. Pitfalls in the ct diagnosis of atlantoaxial rotary subluxation.
Orthopedics an upper cervical spine subluxation which is either rotatory or anterior. Involvement of the cervical spine is common in rheumatoid arthritis ra. 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 created by the vertebrae vertebral canal. Cervical subluxation in rheumatoid arthritis uptodate. The atlantoaxial joints can lose stable articulation from traumatic, inflammatory, idiopathic, or congenital.
Manifestation of radiological abnormalities in psoriatic. Revisiting anterior atlantoaxial subluxation with overlooked information on mr images. Posterior atlantoaxial subluxation due to os odontoideum. Original article classification and surgical management. The first and second vertebrae in the neck are called the atlas and the axis, respectively. To differentiate these groups, we propose a functional. Atlantoaxial subluxation radiology reference article. Between august 1990 and april 1997, 20 children with atlantoaxial rotatory subluxation were treated. Pitfalls in the ct diagnosis of atlantoaxial rotary. No reports have described posterior atlantoaxial subluxation due to os odontoideum combined with spondylotic cervical myelopathy csm, both of which require surgical treatment. Subluxation is another term for dislocation, and atlantoaxial references the top two cervical vertebrae.
Surgical treatment of the severely damaged atlantoaxial joint with. Traumatic atlantoaxial rotatory subluxation emergency. On intraoperative field, c1 rotated to counterclockwise and c1c2 articular capsule was torn. Aars is relatively rare in adults but somewhat more common in children, albeit by a largely different mechanism of action. Abstract objective to determine a flexed position for radiographic diagnosis of atlantoaxial instability aai and to identify radiographic. Subluxation of the atlantoaxial joint occurs when the normal alignment of the first and second vertebrae in the neck is disrupted. She was again treated with gardnerwells traction for two weeks followed by cervical collar for three months. Find powerpoint presentations and slides using the power of, find free presentations research about atlantoaxial subluxation ppt. Combined atlantoaxial rotatory fixation and unilateral. We present the case of a 19yearold caucasian woman with traumatic atlantoaxial subluxation. Jul 18, 2016 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. Intravenous antibiotics and a halo vest were used to treat the patient.
We report a case of delayed myelopathy caused by atlantoaxial subluxation without fracture. To evaluate the surgical results of computerassisted c1c2 transarticular screw fixation for atlantoaxial instability and. Cases were children younger than 16 years with aars after blunt trauma n 55. The clinical features and general medical management of ra, as well as the differential diagnosis and general evaluation of the patient with neck pain and of cervical spine disorders, are discussed separately. Mar 30, 2016 i drank celery juice for 7 days and this is what happened no juicer required. Treatment atlantoaxial subluxation as performed by dr. May 17, 2020 atlantoaxial subluxation refers to a condition affecting the top of the spine. The patient was a 38yearold male who became aware of weakness in extremities. Atlantoaxial subluxation in dogs saint francis veterinary. Some mr imaging findings other than abnormal adi relate to aaa subluxation. Washington university spinal neurosurgeons are national experts in the treatment of instability of the top of the cervical spine, between the first and second cervical vertebrae c1 and c2. Neurologic sequelae secondary to atlantoaxial instability in. Atlantoaxial subluxation msd manual professional edition. The patient had a history of hitting his head severely while diving into a swimming pool at the age of 14 years old.
When dislocation or instability occurs, it may be mild to serious and caused by many different factors. The clinical picture of atlantoaxial subluxation changes when. Atlantoaxial rotary subluxation should be considered in a child with. Jan 26, 2012 example atlantoaxial subluxation surgery as performed by dr. Usually, the treatment of choice is traction using halogardnerwells fixation devices. The left anterior facet of c1 is fixed on the facet of c2, with anterior displacement of the right anterior facet. Atlantoaxial subluxation aas is a disorder of c1c2 causing impairment of stability. Acute atlantoaxial rotary subluxation aars pediatric. Coexisting odontoid subluxation syringomyelia and vertebral artery abnormalities is a rare condition in the spinal cord, and the therapeutic approach of this disease has been also rarely reported. Pdf atlantoaxial subluxation after pyogenic spondylitis. Flexed radiographic angles for determination of atlantoaxial. Atlantoaxial rotatory subluxation is frequently observed in children and in patients with rheumatic arthritis, but rarely occurs traumatically in adults. Diagnosis and treatment of atlantoaxial subluxation. Radiography revealed atlantoaxial subluxation, and an abscess was seen around the odontoid process on magnetic resonance images.
I drank celery juice for 7 days and this is what happened no juicer required. In this lesson, learn about the symptoms and treatment for this type of injury. Anatomy and biomechanics of the craniovertebral junction. The progression of cervical spine instability in ra correlates with. The ct appearances of the atlantoaxial complex were identical in all three groups. Atlantoaxial subluxation definition of atlantoaxial. The spatial relationship of the vertebral bodies was appreciated better in those patients who were studied with table 1. Early reduction three hours after trauma and immobilization using only a soft collar were performed and yielded very good. Atlantoaxial rotatory dislocation aard in pediatric age. Case report of a traumatic atlantoaxial rotatory subluxation. Management consisted of analgesia, sedation, and application of a halo skull traction device. Neurologic symptoms can occur when the spinal cord or adjacent nerve roots are involved. Reduction was accomplished by counter rotation using bone. The disease is common in young toybreed dogs and leads to cervical spinal cord compression 2, 7,8,9, 12, 17, 19, 21, 26, 27, 34, 40, 44,45,46.
A case of delayed myelopathy caused by atlantoaxial. Atlantoaxial transarticular screw fixation, first introduced by magerl and seemann, has proved to be one of the most reliable, stable fixation techniques for treating atlantoaxial subluxation 7, 16. The technique of distraction, compression, extension, and reduction dcer is effective to reduce, realign, and relieve craniospinal compression. Atlantoaxial instabilityc12 disorders wustl department of.
The uppermost cervical vertebra the atlas rotates about the odontoid process of the second cervical vertebra the axis. Congenital vertebral malformations along with abnormality or absence of ligamentous structures lead to contusion or compression of the cervical spinal cord and caudal brainstem. Subaxial subluxation after atlantoaxial transarticular. 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. The symptoms may vary depending on the area of spinal cord. View and download powerpoint presentations on atlantoaxial subluxation ppt. Thirtyseven patients suffering from atlantoaxial dislocation. Congenital atlantoaxial dislocation aad has a high incidence in india. Current trends in management of atlantoaxial dislocation qingshui yin, md, jianhua wang, md orthopaedic hospital, general hospital of guangzhou military command of peoples liberation army, guangzhou, china atlantoaxial dislocation aad, often caused by trauma, tumors or congenital malformations, is a challenging disorder. Atlantoaxial subluxation in dogs basic information description the spine is made up of small bones called vertebrae, which surround and protect the spinal cord.
Although anterior atlantoaxial subluxation is a frequent complication of os odontoideum, posterior subluxation is extremely rare. Atlantooccipital overlapping and its effect on outcomes after ventral. Atlantoaxial subluxation merck manuals professional edition. This condition may lead to chronic atlantoaxial instability or basilar invagination 4. Acute traumatic atlantoaxial rotatory subluxation is often reduced easily. The atlantoaxial subluxation may exist in patients neutral position without neck movement or may occur in relation to neck rotation movements when the patient moves the neck to the right and left. As lesoes da coluna cervical sao frequentemente descritas como eventos catastroficos em. However, at the end of two weeks, she returned with torticollis despite wearing the cervical collar. After removing halo skull traction, full reduction and recovery were achieved without instability. To report and discuss the courses and clinical sequelae of atlantoaxial subluxation in patients with marfan syndrome. Atlantoaxial rotatory subluxation, transverse ligament injury. May, 2020 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 instability aai most commonly affects young, small dog breeds 2, 6. About atlantoaxial jointatlantoaxial joint is the joint between first and second cervical vertebra. In this lesson, learn about the definition and causes of atlantoaxial subluxation. Pertaining to the first and second cervical vertebrae which meet at a joint called the atlantoaxial joint. In seventeen cases of irreducible atlantoaxial rotatory subluxation here called fixation, the striking features were the delay in diagnosis and the persistent clinical and roentgenographic. Atlantoaxial rotary subluxation after minor trauma brad a. Pdf computerassisted c1c2 transarticular screw fixation. The adi is the imaging diagnostic clue to aaa subluxation of the cervical spine. Atlantoaxial joint functionatlantoaxial joint is the junction between neck and skull head. Revisiting anterior atlantoaxial subluxation with overlooked information on mr images s. William mccartney at the north dublin orthopaedic animal hospital.
The aim was to report a rare case of isolated traumatic atlantoaxial rotatory subluxation without ligamentous injury. Grisel syndrome is a rare entity characterized by nontraumatic atlantoaxial rotatory subluxation, which usually occurs after infections of head and neck or after otolaryngology procedures such as adenoidectomy, tonsillectomy, and repair of choanal atresia, among others. 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. Traumatic atlantoaxial rotatory subluxation in an adolescent. The atlantoaxial subluxation changes in psoriatic arthritis may resemble rheumatoid arthritis. Evaluation of atlantooccipital overlapping and cerebral. Atlantoaxial subluxation can result from major trauma or can occur without trauma in patients with rheumatoid arthritis, juvenile idiopathic arthritis, or ankylosing spondylitis. Radiographic analysis of patients with marfan syndrome has shown that increased atlantoaxial. Atlantoaxial rotatory subluxation in patients with marfan sy. Original article classification and surgical management for the axis fracture complicated with adjacent segment instability lei wang 1. The anterior facet of c1 is fixed on the facet of c2.
Radiological measurement, atlantoaxial dislocation, lateral atlantoaxial interval, lateral mass interval. 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. Current trends in management of atlantoaxial dislocation. Atlantoaxial instability aai is a group of disorders caused by congenital dysplasia in the areas from the occipital bone to the cranial cervical vertebrae craniocervical junction abnormality cja. Complete atlantooccipital assimilation with basilar. Clinical summary in rotary subluxation 5mm rather than 3mm sections. Craniocervical junction abnormalities with atlantoaxial subluxation. We present a case of atlantoaxial rotary subluxation after a minor injury managed by manual reduction under sedation. These vertebrae form the atlantoaxial aa joint, which is connected by ligaments. At that time, cervical spine plain xray images showed no fracture, and the cervical pain disappeared after. Usually, the treatment of choice is traction using halogardnerwells fixation devices for up to six weeks. Mar, 2012 fielding and hawkins have classified the atlantoaxial subluxation in four types. The spinal cord is least reinforced in neck compared to thorax and abdomen.
Acute atlantoaxial rotary subluxation aars key points. The joint between the axis and atlas is a pivot type of joint that allows the head turn. Atlantoaxial instabilityc1 2 disorders atlantoaxial instabilityc1 2 disorders. Atlantoaxial subluxation aas, caused by congenital factors, inflammation. The animal made an uneventful and sucessful recovery following surgery. Atlantoaxial dislocation refers to a loss of stability between the atlas and axis c1c2, resulting in loss of normal articulation fig. Fourteen patients 70% were girls and six 30% were boys mean age, 6. A typical clinical sign is torticollis with lateral flexion of the neck and contralateral rotation, known as the cockrobin position. Atlantoaxial subluxation is misalignment of the 1st and 2nd cervical vertebrae, which may occur only with neck flexion. Jan 23, 2012 atlantoaxial rotatory subluxation is rarely caused by trauma in adults. However, this operation has its own risks, notably one of which is an intraoperative injury to the vertebral artery 17, 18. Fixed rotatory subluxation of the atlantoaxial joint. In the early stage of the disease course, anterior atlantoaxial subluxation aaas is the most common rheumatoid abnormality with reported prevalence varying from 19 to 70% depending on patient selection. Management of congenital atlantoaxial dislocation tspace.