Unilateral Alar Ligament Injury: Diagnostic, Clinical, and Biomechanical Features

Ünal, Tuğrul Cem; Dolaş, İlyas; Ünal, Ömer Faruk

doi:10.1016/j.wneu.2019.07.198

Cited by 3 publications

(17 citation statements)

References 26 publications

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“…As is the case with all trauma, patients with concerning CT findings or those with persistent neck pain or midline tenderness should be assessed with MRI to better visualize the ligaments of the upper cervical spine. 11 True alar rupture can be confirmed by visualizing ligamentous discontinuity, which was explicitly seen in 5 (31.3%) of 16 cases. However, current limitations in MRI often make it difficult to identify such disruption, particularly when there is inflammation within the ligament itself or surrounding structures.…”

Section: Discussionmentioning

confidence: 93%

“… 9 This is especially relevant when there is ambiguous signal intensity within the transverse or apical ligament that is of undetermined significance, which could represent an increased risk for dangerous instability, as was the case in three of the patients reported by Unal et al. 11 …”

Section: Discussionmentioning

confidence: 99%

“… 10 Presumably because of its rarity and the sometimes subtle symptom presentation associated with the injury, diagnosis of an IUALI is thought to often be missed when clinical suspicion is lacking, which has uncertain long-term consequences. 11 , 12 …”

Section: Discussionmentioning

confidence: 99%

“…Ipsilateral torticollis was the next most common chief compliant, with only 2 of 16 patients affected (12.5%). 9 , 10 Interestingly, in the report by Unal et al., 11 multiple patients were discharged from the hospital after normal CT scans and were only discovered to have an IUALI after they re-presented with persistent unilateral motion-aggravated neck pain. Together, this underscores two important principles when managing cervical trauma patients.…”

Section: Discussionmentioning

confidence: 99%

“…Isolated unilateral alar ligament injury (IUALI) is seemingly rare, however, with only 16 cases documented in the literature to date. [7][8][9][10][11][12][13][14] Due in part to the rarity of this injury, there is limited understanding of the long-term outcomes associated with IUALI. Therefore, consensus on the best treatment strategy has been lacking in the literature.…”

mentioning

confidence: 99%

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Isolated unilateral alar ligamentous injury: illustrative cases

Reeves,

Valcarce-Aspegren,

Robert

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Isolated unilateral alar ligament injury (IUALI) is a rare and likely underreported occurrence after upper cervical trauma, with only 16 cases documented in the literature to date. Patients generally present with neck pain, and definitive diagnosis is typically made by magnetic resonance imaging (MRI). Unfortunately, likely due in part to its rarity, there are no formal guidelines for the treatment of an IUALI. Furthermore, there is a limited understanding of the long-term consequences associated with its inadequate treatment. OBSERVATIONS Here, the authors report on three pediatric patients, each found to have an IUALI after significant trauma. All patients presented with neck tenderness, and two of the three had associated pain-limited range of neck motion. Imaging revealed either a laterally deviated odontoid process on cervical radiographs and/or MRI evidence of ligamentous strain or discontinuity. Each patient was placed in a hard cervical collar for 1 to 2 months with excellent resolution of symptoms. A comprehensive review of the literature showed that all patients with IUALI who had undergone external immobilization with either rigid cervical collar or halo fixation had favorable outcomes at follow-up. LESSONS For patients with IUALI, a moderate course of nonsurgical management with rigid external immobilization appears to be an adequate first-line treatment.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%