Transverse ligament rupture and atlanto-axial subluxation in children

Floman, Yizhar; Kaplan, Leon; Elidan, Josef; Umansky, Félix

doi:10.1302/0301-620x.73b4.2071650

Cited by 32 publications

(13 citation statements)

References 9 publications

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“…Based on their experience in 4 patients aged 2–9 years old, Floman et al [14] suggested that conservative treatment is not effective for atlantoaxial subluxation caused by injury of the transverse ligament of the atlas, and that surgical treatment should be performed. Dickman et al [15] also suggested that early surgery is indicated in children aged ≥14 years old with a type 1 injury of the transverse ligament, whereas conservative treatment with a rigid cervical orthosis is preferred in patients with a type 2 injury with bone fragments in the ligament attachment; however, failure to achieve bone adhesion with such conservative treatment should be corrected with surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

A Case of Delayed Myelopathy Caused by Atlantoaxial Subluxation without Fracture

Takamatsu

Takahashi

Yokoyama

et al. 2013

Case Reports in Orthopedics

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We report a case of delayed myelopathy caused by atlantoaxial subluxation without fracture. The patient was a 38-year-old male who became aware of weakness in extremities. The patient had a history of hitting his head severely while diving into a swimming pool at the age of 14 years old. At that time, cervical spine plain X-ray images showed no fracture, and the cervical pain disappeared after use of a collar for several weeks. At his first visit to our department, X-ray images showed an unstable atlantoaxial joint. After surgery, weakness of the extremities gradually improved. At 6 months after surgery, bone union was completed and the symptoms disappeared. This case shows that atlantoaxial ligament injuries are difficult to diagnose and may easily be missed. A high level of suspicion is important in such cases, since neurological compromise or deterioration may occur many years after the injury.

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Section: Discussionmentioning

confidence: 99%

A Case of Delayed Myelopathy Caused by Atlantoaxial Subluxation without Fracture

Takamatsu

Takahashi

Yokoyama

et al. 2013

Case Reports in Orthopedics

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“…Despite these problems, the reported success rate using different surgical and nonsurgical techniques is high. [1][2][3][4][5][6][7][8] Traditionally, surgical treatment is done with interlaminar structural bone grafting and sublaminar wire stabilization (Brooks procedure) 9 or structural bone grafting without wiring (Gallie procedure). 10 Both procedures are followed by adjunctive halo vest immobilization.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Atlantoaxial Instability in a 4-Year-Old Child Treated With Harms Technique

Hentenaar

Öner

Royen

2007

JPO Journal of Prosthetics and Orthotics

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A 4-year-old child with a chronic inflammatory syndrome and osteolytic lesions of unknown cause presented with C1-C2 instability and myelopathy. She was treated successfully with posterior atlantoaxial screw arthrodesis with Harms technique. Atlantoaxial instability in children is rare and is usually treated with conventional wiring techniques or transarticular screw fixation (Magerl technique). The latter shows very high fusion rates, but it is technically demanding and has a potential risk of injury to the vertebral artery (VA). In addition, in some cases the procedure cannot be used because of anatomical unsuitability or the presence of fixed subluxation of C1 on C2. To overcome these limitations, Harms developed a technique of fixation with pedicle screws. The technique is easier to apply than transarticular screw fixation and lowers the risks of injury to the VA. Fusion rates are comparable. The authors used polyaxial-head screws and rods for posterior fixation of the atlantoaxial complex in a 4-year-old child. Successful posterior fusion of C1-C2 and decompression of the myelum was achieved. Fixation of the atlantoaxial complex using the Harms technique is an efficient alternative to previously reported fusion techniques for the pediatric population. (J Prosthet Orthot. 2007;19:48-50.) KEY INDEXING TERMS: atlantoaxial instability, cervical fusion, Harms technique, posterior screw fixation O ur patient was born with a chronic inflammatory syndrome and osteolytic lesions of unknown cause. Computed tomography (CT) scan showed osteolytic lesions in the metaphysis of radius and tibia and thickening of all costochondral junctions. This was histologically diagnosed as reactive periostitis. She was treated with high-dose corticosteroids for 2.5 years, complicated by hypertension and osteoporosis. She developed a vertebral collapse of C5-C6 and anterior subluxation of C1 on C2 (Figure 1) after a mild trauma. It was not clear whether the atlantoaxial instability was a result of an inflammatory process.Lateral flexion-extension radiographs were obtained to confirm diagnosis. Magnetic resonance imaging showed a mild myelopathy at C1-C2 region. Physical examination proved involvement of the pyramidal tract with gait abnormality, hyperreflexia, and motor weakness. SURGICAL TECHNIQUEThe C1-C2 subluxation was treated under general anesthesia with a posterior spondylodesis. An Axon-system (Synthes, Inc, West Chester, PA) with four polyaxial-head screws (3.5 mm outer diameter) was used for fixation of the C1 lateral mass and the C2 pedicle. Drilling was guided by anatomic landmarks and fluoroscopy. Polyaxial screws of appropriate length were inserted, then C1 was lowered onto C2 before fixation to the 3-mm rods. Finally, allograft bone chips mixed with bone marrow aspirate were added. Postoperative cervical immobilization was provided with a Minerva cast for 3 weeks.

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“…Traumatic causes of C1/2 instability requiring consideration for fusion include non-united odontoid fracture, 19;20 odontoid fracture with transverse ligament disruption, 21 Jefferson fracture with transverse ligament rupture, 22;23 and ligamentous instability in the absence of a fracture. [24][25][26] Common congenital causes include aplasia 27 and hypoplasia 28 of the odontoid process, and os odontoideum. [29][30][31] Down's syndrome also has a recognized high incidence of this C1/2 instability, 32;33 and associations with Marfan's syndrome [34][35][36] and Ehlers-Danlos syndrome 37;38 have been rarely reported.…”

Section: Discussionmentioning

confidence: 99%