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2016, Number 4

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Acta Med 2016; 14 (4)

Atlantoaxial instability

Alcocer MJL, Domínguez GLG, Mora CJ, Domínguez CLG

Language: Spanish
References: 16
Page: 235-239
PDF size: 236.18 Kb.


ABSTRACT

Background: Atlantoaxial instability, also known as atlantoaxial subluxation, is only identified by radiographic studies with laxity increased between the anterior arch of the atlas and the odontoid process. When a patient has atlantoaxial instability, the incompetence of the transverse ligament or damage to the odontoid process allows a subsequent translation, with potential damage to the spinal cord; therefore, all patients with confirmed instability are restricted from participating in contact sports and sports that require bending or significant cervical flexo-extension. Case report: Nine-year-old female patient; she had practiced gymnastics for the past four years at a competitive level. She began her condition with a neck hyperflexion when falling down from trampoline training; she was managed in the emergency room with a diagnosis of cervical sprain grade I; dynamic radiographic studies and MRI were performed, which showed atlantoaxial subluxation and evidence of inflammation in the atlanto-odontoid space. She required surgery after a failed conservative treatment. Conclusions: Surgical treatment in patients with asymptomatic atlantoaxial subluxation is subject to controversy; arthrodesis is indicated in asymptomatic individuals to reduce the risk of spinal cord injury.


REFERENCES

  1. Wong ST, Ernest K, Fan G, Zovickian J, Pang D. Isolated unilateral rupture of the alar ligament. J Neurosurg Pediatr. 2014; 13: 541-547.

  2. Ulbrich EJ, Eigenheer S, Boesch C, Hodler J, Busato A, Schraner C et al. Alterations of the transverse ligament: an MRI study comparing patients with acute whiplash and matched control subjects. AJR Am J Roentgenol. 2011; 197: 961-967.

  3. Vaccaro RA, Klein RG, Ciccoti M, Pfaff LW, Moulton RM, Hilibrand A et al. Contemporary concepts in spine care return to play criteria for the athlete with cervical spine injuries resulting in stinger and transient quadriplegia/paresis. Spine. 2002; 2: 351-356. (2002) 351-356.

  4. Dickman CA, Greene KA, Sonntag VK. Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery. 1996; 38: 44-50.

  5. Floman Y, Kapan L, Elidan J, Umnasky F. Transverse ligament rupture and atlanto-axial subluxation in children. J Bone Joint Surg Br. 1991; 73: 640-643.

  6. Hobbs WR, Sponseller PD, Weiss AP, Pyeritz RE. The cervical spine in Marfan syndrome. Spine (Phila Pa 1976). 1997; 22: 983-989.

  7. Domínguez CL, Trujillo SM, Segovia A. Síndrome de Grisel: luxación rotatoria atlantoaxoidea. Acta Med. 2005; 3:103-107.

  8. Ferrer SM. Traumatismos de la columna cervical alta: clasificación tipológica, indicaciones terapéuticas y abordajes quirúrgicos (a propósito de 286 casos). Neurocirugía. 2006 17: 391-419.

  9. Mesfar W, Moglo K. Effect of the transverse ligament rupture on the biomechanics of the cervical spine under a compressive loading. Clin Biomech (Bristol, Avon). 2013; 28: 846-852.

  10. Myran R, Kvistad KA, Nygaard OP, Andresen H, Folvik M, Zwart JA. Magnetic resonance imaging assessment of the alar ligaments in whiplash injuries: a case-control study. Spine (Phila Pa 1976). 2008; 33: 2012–2016.

  11. Blatt JM, Shiloni E, Robin GC, Floman Y. Tear of the transverse ligament with atlantoaxial subluxation in childhood. Orthop Transac. 1981; 5: 184-189.

  12. Locke GR, Gardner JI, Van Epps EF. Atlas-dens interval in children: a survey based on 200 normal cervical spines. Am J Roentgenol Radium Ther Nucl Med. 1966; 97: 135-140.

  13. Lindgren KA, Kettunen JA, Paatelma M, Mikkonen RM. Dynamic kinematic magnetic resonance imaging in whiplash patients and in age- and sex-matched controls. Pain Res Manag (Canada). 2009; 14: 427-432.

  14. Claybrooks R, Kayanja M, Milks R, Benzel E. Atlantoaxial fusion: a biomechanical analysis of two C1-C2 fusion techniques. Spine J. 2007; 7: 682-688.

  15. Alpizar-Aguirre A, Lara Cano JG, Rosales L, Miramontes V, Reyes-Sánchez AA. Surgical treatment of craniocervical instability. Review paper. Acta Ortop Mex. 2007; 21: 204-211.

  16. American Academy of Pediatrics Committee on Sports Medicine and Fitness. Atlantoaxial instability in Down syndrome: subject review. Pediatrics. 1995; 96: 151-154.




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