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PubMedDate not supplied

Spontaneous atlantoaxial subluxation as a presenting manifestation of juvenile ankylosing spondylitis. A case report.

Juvenile-onset ankylosing spondylitis is an unusual disorder which can present with either peripheral arthritis or with more classic hip girdle and back symptoms. Atlantoaxial instability has been recognized as a late complication in only one patient and has not been reported as an early manifestation. This paper presents a case in which atlantoaxial instability and neck pain without neurologic involvement was a presenting manifestation. The laboratory and clinical features of juvenile ankylosing spondylitis are discussed, along with the importance of qualitative sacroiliac joint scintigraphy in the diagnosis of early or confusing cases.

Axis, Cervical Vertebra↗
PubMed1985

Computed axial tomography in C1-C2 trauma.

Twenty patients with C1-C2 vertebral trauma underwent computed tomographic (CT) scans to evaluate prospectively its efficiency for diagnosis and treatment. It is suggested that if standard roentgenograms are inconclusive, CT scan is recommended for further evaluation of C1 fractures and C1-C2 rotatory subluxation in preference to tomography and cineradiography. CT scans do not assess dynamic stability and may miss minimally displaced odontoid fractures. It was also concluded that they add little in the treatment of hangman's fractures, although scanning did show that the pathology was often more complex than anticipated. The clinician must be aware of the capabilities and the limitations of the specific scanner in use and work closely with the radiologist to maximize the yield of information. The CT scan is very helpful as an adjunct to standard x-ray studies, but is not recommended as a screening procedure.

Adolescent↗
PubMed1993

Atlantoaxial dislocation as the presenting symptom of ankylosing spondylitis.

A 27-year-old woman presented with nontraumatic atlantoaxial dislocation that required a C1-C2 fusion. A comprehensive investigation initially failed to reveal any evidence of infectious or rheumatologic disease and she remained well for 3 1/2 years, at which time a diagnosis of ankylosing spondylitis was established. There are no other similar cases reported in the medical literature. When dealing with a patient who has experienced a spontaneous atlantoaxial dislocation, a thorough assessment looking for an underlying infectious or inflammatory etiology is mandatory. Furthermore, the authors recommend that any patient who has negative investigations be followed long-term; an underlying covert inflammatory cause may only become evident after significant delay.

Adult↗
PubMed1996

Anterior extraoral surgery to the upper cervical spine.

STUDY DESIGN: A series of 10 patients surgically treated with prevascular or retrovascular extraoral retropharyngeal approach to the upper cervical spine is examined. OBJECTIVES: In orthopedic surgery, retropharyngeal approach may replace the transoral surgery, obviating the risks of infection and the uncomfortable postoperative course of cases in which median labiomandibular glossotomy was used to accomplish complex bone reconstruction. SUMMARY OF THE BACKGROUND DATA: The transoral approach is reported in literature as the classical anterior access to the upper cervical spine that provides direct exposure for anterior decompression of the spinal cord. The risks, the surgical limits, and the postoperative difficulties of transmucosal access suggest the use of an anterior extraoral retropharyngeal approach in orthopedic surgery. METHODS: The series includes four neoplastic lesions (osteoma, aneurismal bone cyst, giant cell tumor, solitary metastasis), three retropharyngeal ossifications resulting from diffuse idiopathic skeletal hyperostosis, and a single case of os odontoideum, craniocervical malformation, and postlaminectomy kyphosis. RESULTS: At follow-up evaluation, all patients achieved a satisfactory outcome, with good clinical and radiographic results; nasotracheal intubation obviated the need for tracheostomy. The wide surgical exposure allowed reconstruction with iliac strut bone grafts and internal fixation in six patients, avoiding the need of a halo device. The only complications were four instances of transient palsies of the marginal mandibular branch of the facial nerve. CONCLUSIONS: In the anterior surgery of the upper cervical spine, the prevascular approach allows a wide surgical exposure, with visualization similar to that obtained with median labiomandibular glossotomy. The retrovascular approach is indicated in selected cases, such as tumor adjacent to the vertebral artery and C1-C2 arthrodesis with bilateral transarticular screws according to Barbour.

Adolescent↗
PubMed1997

Traumatic vertical atlantoaxial instability in a case of atlanto-occipital coalition.

STUDY DESIGN: This is a report of a woman with an atlanto-occipital coalition who experienced a traumatic vertical atlantoaxial facet dislocation and severe associated neurologic injury. OBJECTIVE: To describe the radiographic and pathoanatomic characteristics of the injury process. SUMMARY OF BACKGROUND DATA: Severe injuries of the occipito-atlantoaxial complex are uncommon and only rarely are associated with patient survival. This is the first report of this particular injury. METHODS: Plain radiography and tomography demonstrated the facet dislocation and instability of the injury. Surgical exploration for repair of the torn dura mater and bony arthrodesis demonstrated the gross pathoanatomy. RESULTS: The patient's vertical atlantoaxial instability was stabilized, her dura mater reconstructed, and her necrologic status has improved to allow mobilization with a cane. CONCLUSION: Vertical atlantoaxial instability has not been described previously. From the somewhat subtle radiographic findings, one might underestimate the severity of the neurologic damage. Aggressive work-up and management of this injury is suggested to avoid potential further necrologic sequelae.

Accidents, Traffic↗
PubMed2000

Atlantoaxial subluxation associated with ossification of posterior longitudinal ligament of the cervical spine.

STUDY DESIGN: Two case reports. OBJECTIVE: To demonstrate two rare cases of atlantoaxial subluxation associated with ossification of the posterior longitudinal ligament of the cervical spine, in which spastic quadriplegia developed. SUMMARY OF BACKGROUND DATA: There are only two reports of an association of diffuse idiopathic skeletal hyperostosis with atlantoaxial subluxation. This condition often accompanies ossification of the posterior longitudinal ligament of the cervical spine, but there is nothing in the literature about the association of ossification of the posterior longitudinal ligament with atlantoaxial subluxation. METHODS: Clinical and radiographic findings of these two cases were demonstrated. In both cases laminoplasty of the cervical spine was performed with occipitoaxial arthrodesis. RESULTS: The spastic quadriplegia of these two patients caused by myelocompression improved after surgical intervention. CONCLUSION: Ossification of the posterior longitudinal ligament of the cervical spine may cause atlantoaxial subluxation.

Aged↗
PubMed2001

Traumatic atlantoaxial distraction injury: a case report.

STUDY DESIGN: Case report. OBJECTIVES: Description of a rarely reported variant of traumatic C1-C2 dislocation and discussion of a favorable outcome in a nonsurgical treatment approach. SUMMARY OF BACKGROUND DATA: Atlantoaxial dislocation most commonly involves an anterior movement of C1 in relation to C2. Often, the integrity of the transverse ligament or odontoid process is compromised, and the atlantodental interval changed. The described patient sustained a purely craniocaudal atlantoaxial distractive lesion secondary to injury sustained in a high-speed motor vehicle accident. RESULTS: The initial treatment plan involved surgical stabilization subsequent to healing of a C1 ring fracture. After 12 weeks of external stabilization, ligamentous damage appeared well resolved. That there was no gross instability delayed using a surgical option. At periodic checkup, the patient was without symptoms. CONCLUSION: In this case, conservative management of a ligamentous C1-C2 injury was effective. At 5 years after trauma the patient was without sequelae. This outcome is in contrast to previous management of injuries of this type, all of which involved surgical intervention.

Accidents, Traffic↗
PubMed2004

Cervical angina caused by atlantoaxial instability.

Cervical angina is defined as a paroxysmal precordialgia that resembles true cardiac angina caused by cervical spondylosis. Cervical angina most commonly results from compression of the C7 ventral root. We present here a case of cervical angina caused by atlantoaxial instability. This case had marked atlantoaxial instability but no flexibility of the middle to lower levels of the cervical spine. Although there was mild C7 root compression on the radiologic findings, the chest pain was induced by neck motion, and the precordialgia disappeared after posterior atlantoaxial fusion without C7 root decompression. Therefore, we diagnosed this case as cervical angina caused by spinal cord compression at the C1-C2 level. It was speculated that a perturbation of the sympathetic nervous system or a hypofunction of the pain suppression pathway in the posterior horn of the spinal cord caused the pectoralgia. Although cervical angina is a rare disease, physicians should be aware of it; if there are no abnormal findings on cardiac examinations for angina pectoris, they should examine the cervical spine. Cervical angina due to atlantoaxial instability is one of the differential diagnoses of precordialgia.

Afferent Pathways↗
PubMed2005

Tectorial membrane injuries in children.

We report three cases of tectorial membrane injury in children. An increased interspinous ratio was identified on cervical spine radiographs. The tectorial membrane injuries were diagnosed by magnetic resonance imaging. The three children were restrained passengers in high-speed motor vehicle accidents, and all sustained polytrauma. Two children with partial tears of the tectorial membrane were immobilized in a halo, and one with a longitudinal tear of the tectorial membrane had an occiput-to-C2 fusion.

Accidents, Traffic↗
PubMedDate not supplied

Traumatic atlantoaxial subluxation in children.

We report four children who sustained traumatic atlantoaxial subluxation without a rotatory component, underlying congenital anomaly, or inflammatory cause. Three patients were involved in motor vehicle accidents as pedestrians, and one sustained a rugby injury to his neck. Only one patient sustained an associated head injury. Two patients had neurologic signs on admission directly attributable to the atlantoaxial subluxation. The signs resolved after reduction and stabilization of the subluxation. Three patients were treated conservatively and one operatively. To date, all four patients have had a satisfactory outcome.

Accidents, Traffic↗