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. Apr 08, 2020 atlantoaxial subluxation refers to a condition affecting the top of the spine. Pdf on jan 1, 2017, mishra dk and others published atlantoaxial subluxation of. Atlantoaxial subluxation in dogs basic information description the spine is made up of small bones called vertebrae, which surround and protect the spinal cord.
Atlantoaxial instability has been described as a manifestation of. Learning radiology atlantoaxial subluxation, dislocation. Traumatic causes of torticollis include atlantoaxial rotatory subluxation, atlantoaxial dislocation, cervical vertebral fractures, and injury to the cervical musculature. When dislocation or instability occurs, it may be mild to serious and caused by many different factors. Operations had been performed with the use of local anesthesia, and it was assumed that, during the injection of anesthetics, bacteria infected the prevertebral space. Traumatic atlantoaxial rotatory fixation in an adult patient.
Atlantoaxial dislocation and instability develops secondarily to paravertebral abscesses, only rarely. Atlantoaxial instability, veterinary clinics of north america. This is a pdf file of an article that has undergone enhancements after acceptance. Atlantoaxial dislocation vertebral column spinal cord. Acute atlantoaxial rotary subluxation aars key points. This paper presents a case of posttraumatic atlantoaxial dislocation, which showed no neurological deficit at the time of the accident, but was later presented. It is also referred to as nontraumatic atlantoaxial rotatory subluxation, torticollis, or grisel syndrome, after the french otolaryngologist who described it in 1930. Atlantoaxial instability is defined by an increase in the predentate space of greater then 3 mm in adults and 5 mm in children. Case report of a traumatic atlantoaxial rotatory subluxation. Atlantoaxial subluxation in dogs saint francis veterinary. The transverse ligament is the primary restraint against atlantoaxial, anteroposterior movement. Atlantoaxial subluxation is a condition where the vertebra in the neck become slightly dislocated or misaligned. Craniocervical junction abnormalities with atlantoaxial subluxation. Torticollis and neck pains should be taken seriously for the purpose of early diagnosis of patients at risk in endemic regions.
Orthopedics an upper cervical spine subluxation which is either rotatory or anterior. The ct appearances of the atlantoaxial complex were identical in all three groups. In 7 of these 10 patients vertical subluxation of the atlas was responsible for the neural deficit. After tonsillectomy, atlantoaxial subluxation occurred in two patients. Pitfalls in the ct diagnosis of atlantoaxial rotary. Usually, the treatment of choice is traction using halogardnerwells fixation devices for up to six weeks. Traumatic atlantoaxial subluxation, posterior transfacet fixation. Jan 23, 2012 atlantoaxial rotatory subluxation is rarely caused by trauma in adults. It may be associated with dislocation of the lateral mass of c1 on c2. The left anterior facet of c1 is fixed on the facet of c2, with anterior displacement of the right anterior facet. Brucella case that led to atlantoaxial spinal instability. Computed tomography ct of the head showed multiple subacute cerebral infarctions in the territory of the right vertebral artery va.
Many congenital abnormalities of the cervical spine are. However, at the end of two weeks, she returned with torticollis despite wearing the cervical collar. Rheumatoid arthritisatlantoaxial subluxation and its clinical presentation. This paper presents a case of posttraumatic atlantoaxial dislo. Following a laminectomy and occipitocervical fusion with a ransford loop, the patients symptoms significantly improved. Brucella case that led to atlantoaxial spinal instability in. Pdf traumatic atlantoaxial dislocation due to ligamentous and combined osseous injuries rarely occurs in adults. 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.
This article highlights a case of atlantoaxial rotatory subluxation with the aim of improving awareness of this condition to enable early recognition. This lesion, untreated, may result in damage to the spinal cord, paresis or sudden death. She was again treated with gardnerwells traction for two weeks followed by cervical collar for three months. Pathogenesis of nontraumatic atlantoaxial subluxation. In this lesson, learn about the symptoms and treatment for this type of injury.
Sep 24, 2014 it is also referred to as nontraumatic atlantoaxial rotatory subluxation, torticollis, or grisel syndrome, after the french otolaryngologist who described it in 1930. Discuss the spectrum of severity of atlantoaxial subluxation in children 2. 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. Children affected with down syndrome frequently require otolaryngologic. Disregarding atlantoaxial instability in toy breed dogs associated with dens. Posterior atlantoaxial fusion using a c2 transverse foramen. William mccartney at the north dublin orthopaedic animal hospital. Common causes of atlantoaxial rotatory subluxation are trauma and infection. Atlantoaxial subluxation aas is a disorder of c1c2 causing impairment of stability.
We present a unique surgical technique for c12 transarticular screw placement utilizing a novel trajectory. Jan 11, 2017 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. Know the causes, symptoms, diagnosis, treatment, prognosis. Pdf atlantoaxial subluxation of the cervical spine as the initial. The aim was to report a rare case of isolated traumatic atlantoaxial rotatory subluxation without ligamentous injury. The cervical magnetic resonance image revealed atlantoaxial subluxation type 2. Pertaining to the first and second cervical vertebrae which meet at a joint called the atlantoaxial joint. Europe pmc is an archive of life sciences journal literature. 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. The first and second vertebrae in the neck are called the atlas and the axis, respectively.
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. Jul 18, 2016 diagnosis and treatment of atlantoaxial subluxation beverly k. The initial symptoms of the prevertebral space infection. In a nontraumatic setting flexion and extension views may be performed. Radiographs of the cervical spine revealed atlantoaxial subluxation aas that could not be reduced.
Some mr imaging findings other than abnormal adi relate to aaa subluxation. Neurologic sequelae secondary to atlantoaxial instability. We present a case report of a 6yearold boy with gs that resulted from a retropharyngeal abscess. Although recent development of screw instrumentation techniques for rigid fixation of the atlantoaxial joint has increased surgical options, patients in whom screws of any type cannot be safely placed are sometimes encountered. Retrospective analysis of surgical outcomes for atlantoaxial.
The purposes of this article are to define atlantoaxial instability aai. Disability and instability of the unique atlantoaxial joint result in controversies regarding the management of acute trauma and also the screening evaluation of particular atrisk individuals. Abstractdown syndrome, the most common chromosomal abnormality, may be associated with various. Diagnosis and treatment of atlantoaxial subluxation. The animal made an uneventful and sucessful recovery following surgery. Find powerpoint presentations and slides using the power of, find free presentations research about atlantoaxial subluxation ppt. Atlantoaxial subluxation in different intraoperative head. There is no wellestablished protocol in the management of patients without spontaneous reduction. Vertical atlantoaxial subluxation, measurement methods. Atlantoaxial dislocation free download as powerpoint presentation. Occipital headache, present in of 22 patients, was often aggravated by working with the head in forward flexion. Asymptomatic moyamoya syndrome, atlantoaxial subluxation and.
Original research revisiting anterior atlantoaxial subluxation with overlooked information on mr images s. Neurologic sequelae secondary to atlantoaxial instability in. Both diagnostic and therapeutic delay may be a potential cause of severe neurological. In a cohort of 55 rheumatoid cervical patients who. The discovertebral joints in the cervical spine may be affected in patients with rheumatoid arthritis ra with resulting osteochondral destruction. Vertical atlantoaxial subluxation, measurement methods openi. A diagnosis was not made until 2 months after the occurrence of infection. Atlantoaxial subluxation of the cervical spine as the initial presentation of rheumatoid arthritis. Download fulltext pdf download fulltext pdf retrospective analysis of surgical outcomes for atlantoaxial subluxation article pdf available in journal of orthopaedic surgery and research 141. Traumatic atlantoaxial rotatory subluxation is predominantly a paediatric phenomenon, with rare occurrence in. Neurologic symptoms can occur when the spinal cord or adjacent nerve roots are involved. 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. Atlantoaxial instability, veterinary clinics of north.
Atlantoaxial subluxation refers to a condition affecting the top of the spine. Traumatic atlantoaxial rotatory subluxation emergency. 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. Asymptomatic moyamoya syndrome, atlantoaxial subluxation. Pdf retrospective analysis of surgical outcomes for. Subluxation of the atlantoaxial joint occurs when the normal alignment of the first and second vertebrae in the neck is disrupted. Atlantoaxial subluxation as an early manifestation in an. 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.
Both diagnostic and therapeutic delay may be a potential cause of severe neurological damage or even. Traumatic atlantoaxial rotatory fixation in an adult. The anterior facet of c1 is fixed on the facet of c2. Nontraumatic atlantoaxial subluxation aas is an uncommon complication of upper neck inflammatory processes and head and neck surgery. The surgical treatment principles of atlantoaxial instability. There are several ways in which a subluxation can occur.
Rheumatoid arthritisatlantoaxial subluxation and its. The atlantoaxial joint is one of the complex and important joint in the body. The adi is the imaging diagnostic clue to aaa subluxation of the cervical spine. Define grisels syndrome, and discuss the pathophysiology of this condition 3. Radiographic findings consistent with atlantoaxial subluxation include dorsal displacement of the axis into the. 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. Nondisplaced fracture or dislocation of atlantoaxial joint results in severe pain, numbness and weakness in upper extremities. Atlantoaxial subluxation is a disorder of c1c2 causing impairment in rotation of the neck. Atlantoaxial rotatory subluxation is rarely caused by trauma in adults. Traumatic atlantoaxial rotatory subluxation in an adolescent. Like brucellosis of childhood, granulomatous infectious diseases rarely cause atlantoaxial subluxation or dislocation. A decrease in anterior atlantoaxial subluxation was noted in a subgroup of seven patients with ra and unstable atlantoaxial joints during active isometric neck flexor muscle contraction. Pdf iatrogenic atlantoaxial rotatory subluxation after. Describe a treatment approach to nontraumatic atlantoaxial subluxation in children 4.
Spinal mri confirmed the atlantoaxial subluxation with an anterior distance of 8 mm, with marked. Key points atlantoaxial instability is a congenital condition affecting toy breed dogs. 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. The atlantoaxial joint stabilizes the neck during activities and at rest. Treatments of atlantoaxial rotatory subluxation in children are generally. Revisiting anterior atlantoaxial subluxation with overlooked information on mr images s. Mar 01, 2016 key points atlantoaxial instability is a congenital condition affecting toy breed dogs. Jan 26, 2012 example atlantoaxial subluxation surgery as performed by dr. Atlantoaxial subluxation aas is characterized by excessive movement at the junction between the atlas c1 and axis c2 as a result of either. Ninetytwo patients 57% had upper cervical involvement, which progressed into anterior atlantoaxial subluxation, vertical subluxation, and both. This article is from korean journal of pediatrics, volume 56. Pdf traumatic atlantoaxial and fracturerelated dislocation. 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.
Atlantoaxial subluxation radiology reference article. The atlantoaxial joints can lose stable articulation from traumatic, inflammatory, idiopathic, or congenital abnormalities. Atlantoaxial instability of inflammatory origin in adults. It is also known under the eponym of grisels syndrome gs. This article is from journal of medical case reports, volume 5. Management consisted of analgesia, sedation, and application of a halo skull traction device. Early reduction three hours after trauma and immobilization using only a soft collar were performed and yielded very good. Atlantoaxial subluxation definition of atlantoaxial. We present the case of a 19yearold caucasian woman with traumatic atlantoaxial subluxation. 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. Posterior atlantoaxial fusion using a c2 transverse.
In this lesson, learn about the definition and causes of atlantoaxial subluxation. Disorders of the cervical spine that occur as complications of rheumatoid arthritis ra include 1 atlantoaxial subluxation aas, anterior or rarely posterior. 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 subluxation. Discuss imaging of atlantoaxial subluxation in children. The uppermost cervical vertebra the atlas rotates about the odontoid process of the second cervical vertebra the axis. 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. Atlantoaxial instability aai and more rarely odontoid pannus formation, similar to the one observed in.
View and download powerpoint presentations on atlantoaxial subluxation ppt. After removing halo skull traction, full reduction and recovery were achieved without instability. Atlantoaxial dislocation refers to a loss of stability between the atlas and axis c1c2, resulting in loss of normal articulation fig. These vertebrae form the atlantoaxial aa joint, which is connected by ligaments. Example atlantoaxial subluxation surgery as performed by dr. Acute atlantoaxial rotary subluxation aars pediatric. The joint between the axis and atlas is a pivot type of joint that allows the head turn.
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