Abstract. The clinical problems, treatment and results are discussed in 23 cases of atlanto-axial dislocation.Key words: Atlanto-axial dislocation.INTEREST in the subject of atlanto-axia1 injuries and affections has grown over the years. A large number of papers have been published in the last 50 years. Ac cording to Washington (1959), Bell (1830) first described a case of infective aetiology while Block1ey and Purser (1956) attributed the earliest description of traumatic cases to Corner (1907), Fritzche (1912) and Jefferson (1927). Reports of a series of cases have been published more recently by Block1ey and Purser (1956), Lipscomb (1957), Sherk andNicholson (1970), and Wadia (1967). AnatomyThe most important features are: 1. The relationship between skull and the axis with the weak atlas lying be tween the two stronger bones. The stability of atlas on axis is dependent on transverse ligament aided by the alar ligaments.2. The ossification of the odontoid process of axis may be incomplete with a plate of cartilage persisting at the base and acting as a weak point. The tip may also remain separate.3. Congenital anomalies at this level are well known and may take the form of absence or hypoplasia of odontoid process, and poor formation transverse ligaments. Both these predispose to a dislocation at slight injury.4. The position of oro-and naso-pharynx in front of vertebrae result in infective processes affecting these vertebrae. Patho g enesisCases of atlanto-axia1 dislocations can be grouped in three groups: (1) trau matic; (2) infective; and (3) rheumatoid.At the J.J. Group of Hospitals we have studied 40 cases in the last 20 years. Their age and sex distributions are shown in Table I. As only one case of rheuma toid variety-anky10sing spondylitis was seen, it has not been separately tabled. Traumatic GroupThere were 23 cases in this group subdivided into four groups (Table II). Burst fractures were produced by forces acting vertically with a double break in the ring of atlas bilaterally. As the fragments tended to move outwards, the chances of cord affection were less. The other three groups were classical flexion injuries with forces acting from above and behind, forwards and downwards. No case of extension injury has been recorded in our series. Where there was a congenital absence of odontoid or weakness of ligaments, the force required to produce the dislocation was much less than where odontoid was fractured. These occurred mainly in children. The following case histories illustrate these points. Cases 2 and 3: Dislocation of atlas with fracture odontoid process. Case 2. A I4-year-old boy with history of a fall from 3 ft, 2-3 years earlier and progressive weakness in last 4 months. Examination showed spasticity, motor weakness and exaggerated jerk. Radio grams showed dislocation of atlas with fracture of odontoid and moderate mobility.Case 3. A 22-year-old man who complained of pain and stiffness in his neck for 4 months following a fall from a swing but no neurological deficit.Case 4: Dislocation o...
THIS paper is in many ways different from the others in as much as it does not deal with the scientific aspect of this problem, but rather the socioeconomic aspects of an affliction when suffered in a country which is a strange mixture of the modern and the ancient. While in the larger cities and hospitals we can muster quite a fair amount of modern technology and surgical skill, the day when the patient returns to his native village he is living under primitive conditions, lacking in such basic requirements as minimum home facilities, medical help, freedom of space to move at home, rutted and muddy roads unsuited for moving on wheelchairs or hand-operated tricycles. The lack of basic education in many patients makes the choice of a new vocation more difficult.During the last four years a small paraplegic unit has been functioning at the J. J. Group of Hospitals. All 60 cases of traumatic paraplegia have been treated by us. Their age, sex and occupational status and cause of the accident are shown in Tables I-III. Table I shows the age and sex incidence among our cases. As is usual the most common incidence is among males of 21-30 years. The overall picture also shows a considerable predominance of males over females, 92 per cent to eight per cent. The oldest patient was of 75 years and the youngest II years.
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