Atlanto-axial dislocations

Abstract

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...

Atlanto-axial subluxation (Grisel's syndrome) following otolaryngological diseases and procedures

“…If the spine is stable conservative measures and regular review may be appropriate. However, several authors (Sullivan et al, 1958;Masalawala, 1977) have suggested that in this situation the above measures may not be sufficient. If there are neurological signs or suspected instability operative decompression and arthrodesis is required (Fielding and Hawkins, 1977;Phillips and Hensinger, 1989).…”

Posterior atlantoaxial dislocation without fracture

“…4,5,9 One case was treated with transoral resection of the odontoid process and the anterior arch of C-1 with subsequent posterior fusion. 6,8 The transverse ligament must have been severely damaged, although not necessarily ruptured. Because this type of injury is associated with severe ligament injury, spontaneous reduction may have occurred, therefore eliminating the necessity of excising the odontoid process via the transoral route.…”

Transoral digital reduction of complete anterior odontoid dislocation followed by fiducial-based navigated transcondylar screw fixation: illustrative case

“…12,13 These dislocations are often precipitated by extreme force traumas that can result in immediate mortality due to compression of the spinal cord. 1,2,6,12,14,15 Those who are fortunate enough to survive this type of injury find themselves on the opposite end of the mortality spectrum and have few if any neurological deficits directly related to the spinal column injury. 1,[3][4][5] Nontraumatic dislocations of the dens can also occur and are due to congenital defects, metastatic tumors, and inflammatory disease.…”