Atlantoaxial instability: Difference between revisions

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== Symptoms ==
== Symptoms ==


** Neck pain<ref name=":0" />
* Neck pain<ref name=":0" />
** Neck stiffness, torticollis<ref name=":1">{{Cite journal|last=Cohen|first=William I.|date=1998-02-01|title=Atlantoaxial Instability: What's Next?|url=https://jamanetwork.com/journals/jamapediatrics/fullarticle/189216|journal=Archives of Pediatrics & Adolescent Medicine|language=en|volume=152|issue=2|pages=119–122|doi=10.1001/archpedi.152.2.119|issn=1072-4710}}</ref>
* Neck stiffness, torticollis<ref name=":1">{{Cite journal|last=Cohen|first=William I.|date=1998-02-01|title=Atlantoaxial Instability: What's Next?|url=https://jamanetwork.com/journals/jamapediatrics/fullarticle/189216|journal=Archives of Pediatrics & Adolescent Medicine|language=en|volume=152|issue=2|pages=119–122|doi=10.1001/archpedi.152.2.119|issn=1072-4710}}</ref>
** Myelopathy<ref name=":0" />
* Myelopathy<ref name=":0" />
** Spasticity<ref name=":0" />
* Spasticity<ref name=":0" />
** Radius are symptoms<ref name=":0" />
* Radius are symptoms<ref name=":0" />
** Lack of coordination<ref name=":0" />
* Lack of coordination<ref name=":0" />
** Clumsiness<ref name=":0" />
* Clumsiness<ref name=":0" />
** Gait changes, difficulty with gait<ref name=":0" /><ref name=":1" />
* Gait changes, difficulty with gait<ref name=":0" /><ref name=":1" />
** Sensory deficits<ref name=":0" />
* Sensory deficits<ref name=":0" />
** Neurogenic bladder<ref name=":0" />
* Neurogenic bladder<ref name=":0" />
** Spasticity, clonus, hyperreflexia<ref name=":0" /><ref name=":1" />
* Spasticity, clonus, hyperreflexia<ref name=":0" /><ref name=":1" />
** Paraplegia, quadriplegia<ref name=":0" />
* Paraplegia, quadriplegia<ref name=":0" />
** Muscle weakness<ref name=":2">{{Cite web|url=https://www.orthobullets.com/spine/2049/atlantoaxial-instability|title=Atlantoaxial Instability - Spine - Orthobullets|website=www.orthobullets.com|access-date=2019-12-10}}</ref>
* Muscle weakness<ref name=":2">{{Cite web|url=https://www.orthobullets.com/spine/2049/atlantoaxial-instability|title=Atlantoaxial Instability - Spine - Orthobullets|website=www.orthobullets.com|access-date=2019-12-10}}</ref>
** Decreased hand dexterity<ref name=":2" />
* Decreased hand dexterity<ref name=":2" />
** Blurred vision<ref name=":3" />
* Blurred vision<ref name=":3" />
** Occipital headache<ref name=":3" />
* Occipital headache<ref name=":3" />


== Risk factors and causes ==
== Risk factors and causes ==

Revision as of 05:59, December 10, 2019

Atlantoaxial instability (AAI) is characterized by excessive movement at the junction between the atlas (C1) and axis (C2) as a result of either a bone or ligament abnormality.

It can be caused by congenital conditions, inflammatory conditions like rheumatoid arthritis, as a result of physical trauma, or infection.[1] It has been associated with Down’s Syndrome, Morquio's syndrome[2], Marfan syndrome.[3][4], and Ehlers-Danlos syndrome.[5][6][7][8][9][10][11][12][13]

It often co-occurs with craniocervical instability (CCI).

In individuals without predisposing conditions, it is thought to be extremely rare.[14]

Symptoms[edit | edit source]

  • Neck pain[14]
  • Neck stiffness, torticollis[15]
  • Myelopathy[14]
  • Spasticity[14]
  • Radius are symptoms[14]
  • Lack of coordination[14]
  • Clumsiness[14]
  • Gait changes, difficulty with gait[14][15]
  • Sensory deficits[14]
  • Neurogenic bladder[14]
  • Spasticity, clonus, hyperreflexia[14][15]
  • Paraplegia, quadriplegia[14]
  • Muscle weakness[16]
  • Decreased hand dexterity[16]
  • Blurred vision[4]
  • Occipital headache[4]

Risk factors and causes[edit | edit source]

Congenital causes[edit | edit source]

Rheumatoid arthritis[edit | edit source]

Chronic inflammation can cause laxity and stretching of the transverse ligament, the formation of a pannus, as well as bone erosion.[14]

Grisel’s syndrome[edit | edit source]

Grisel’s syndrome occurs following inflammation of the soft tissue as a consequence of surgery or infection,[17] frequently an upper respiratory infection. It is primarily seen in patients ages 5-12 but can also be seen in adults.[17] It usually presents with torticollis, neck pain, neck tilt, and stiffness.[18] It can often be treated with conservative therapies such as physical therapy, traction, immobilization, antiinflammatories and treatment of any underlying infection.[18]

Co-morbid conditions[edit | edit source]

AAI can cause vertebrobasilar insufficiency.[19]

Diagnosis[edit | edit source]

AAI is defined as an atlantodental (or atlantodens or atlas-dens) interval (ADI) of greater than 3 mm in adults and of greater than 5 mm in children as measured on plain radiography. The ADI is the distance between the odontoid process and the posterior border of the anterior arch of the atlas.

Treatment[edit | edit source]

See also[edit | edit source]

Learn more

References[edit | edit source]

  1. "Atlantoaxial Instability: Background, Pathophysiology, Etiology". November 10, 2019. Cite journal requires |journal= (help)
  2. Li, Ming-Feng; Chiu, Pao-Chin; Weng, Mei-Jui; Lai, Ping-Hong (December 13, 2010). "Atlantoaxial Instability and Cervical Cord Compression in Morquio Syndrome". Archives of Neurology. 67 (12): 1530–1530. doi:10.1001/archneurol.2010.308. ISSN 0003-9942.
  3. Herzka, Andrea; Sponseller, Paul D.; Pyeritz, Reed E. (February 15, 2000). "Atlantoaxial Rotatory Subluxation in Patients With Marfan Syndrome: A Report of Three Cases". Spine. 25 (4): 524. ISSN 0362-2436.
  4. 4.0 4.1 4.2 MacKenzie, James MacKintosh; Rankin, Rosslyn (2003-12). "Sudden Death Due to Atlantoaxial Subluxation in Marfan Syndrome". The American Journal of Forensic Medicine and Pathology. 24 (4): 369. doi:10.1097/01.paf.0000097853.26115.bb. ISSN 0195-7910. Check date values in: |date= (help)
  5. "Europe PMC". europepmc.org. Retrieved December 10, 2019.
  6. Henderson, Fraser C.; Austin, Claudiu; Benzel, Edward; Bolognese, Paolo; Ellenbogen, Richard; Francomano, Clair A.; Ireton, Candace; Klinge, Petra; Koby, Myles (2017). "Neurological and spinal manifestations of the Ehlers–Danlos syndromes". American Journal of Medical Genetics Part C: Seminars in Medical Genetics. 175 (1): 195–211. doi:10.1002/ajmg.c.31549. ISSN 1552-4876.
  7. Castori, Marco; Morlino, Silvia; Ghibellini, Giulia; Celletti, Claudia; Camerota, Filippo; Grammatico, Paola (2015). "Connective tissue, Ehlers–Danlos syndrome(s), and head and cervical pain". American Journal of Medical Genetics Part C: Seminars in Medical Genetics. 169 (1): 84–96. doi:10.1002/ajmg.c.31426. ISSN 1552-4876.
  8. Lane, D. (August 1, 2006). "Anaesthetic Implications of Vascular Type Ehlers-Danlos Syndrome". Anaesthesia and Intensive Care. 34 (4): 501–505. doi:10.1177/0310057X0603400412. ISSN 0310-057X.
  9. Dordoni, Chiara; Ciaccio, Claudia; Venturini, Marina; Calzavara‐Pinton, Piergiacomo; Ritelli, Marco; Colombi, Marina (2016). "Further delineation of FKBP14-related Ehlers–Danlos syndrome: A patient with early vascular complications and non-progressive kyphoscoliosis, and literature review". American Journal of Medical Genetics Part A. 170 (8): 2031–2038. doi:10.1002/ajmg.a.37728. ISSN 1552-4833.
  10. Giunta, Cecilia; Baumann, Matthias; Fauth, Christine; Lindert, Uschi; Abdalla, Ebtesam M.; Brady, Angela F.; Collins, James; Dastgir, Jahannaz; Donkervoort, Sandra (2018-01). "A cohort of 17 patients with kyphoscoliotic Ehlers–Danlos syndrome caused by biallelic mutations in FKBP14 : expansion of the clinical and mutational spectrum and description of the natural history". Genetics in Medicine. 20 (1): 42–54. doi:10.1038/gim.2017.70. ISSN 1530-0366. Check date values in: |date= (help)
  11. "Europe PMC". europepmc.org. Retrieved December 10, 2019.
  12. Galan, Enrique; Kousseff, Boris G. (April 1, 1995). "Peripheral neuropathy in Ehlers-Danlos syndrome". Pediatric Neurology. 12 (3): 242–245. doi:10.1016/0887-8994(95)00003-X. ISSN 0887-8994.
  13. Wills, Brian P. D.; Dormans, John P. (2006-04). "Nontraumatic Upper Cervical Spine Instability in Children". JAAOS - Journal of the American Academy of Orthopaedic Surgeons. 14 (4): 233. ISSN 1067-151X. Check date values in: |date= (help)
  14. 14.00 14.01 14.02 14.03 14.04 14.05 14.06 14.07 14.08 14.09 14.10 14.11 14.12 Lacy, Jordan; Gillis, Christopher C. (2019). "Atlantoaxial Instability". Treasure Island (FL): StatPearls Publishing. PMID 30137847. Cite journal requires |journal= (help)
  15. 15.0 15.1 15.2 Cohen, William I. (February 1, 1998). "Atlantoaxial Instability: What's Next?". Archives of Pediatrics & Adolescent Medicine. 152 (2): 119–122. doi:10.1001/archpedi.152.2.119. ISSN 1072-4710.
  16. 16.0 16.1 "Atlantoaxial Instability - Spine - Orthobullets". www.orthobullets.com. Retrieved December 10, 2019.
  17. 17.0 17.1 "Atlantoaxial Instability: Background, Pathophysiology, Etiology". November 10, 2019. Cite journal requires |journal= (help)
  18. 18.0 18.1 Fernández Cornejo, Víctor J.; Martínez-Lage, Juan F.; Piqueras, Claudio; Gelabert, Amparo; Poza, Máximo (June 1, 2003). "Inflammatory atlanto-axial subluxation (Grisel's syndrome) in children: clinical diagnosis and management". Child's Nervous System. 19 (5): 342–347. doi:10.1007/s00381-003-0749-6. ISSN 1433-0350.
  19. Vinchon, Matthieu; Assaker, Richard; Leclerc, Xavier; Lejeune, Jean-Paul (April 1, 1995). "Vertebrobasilar Insufficiency Resulting from Traumatic Atlantoaxial InstabilityCase Report". Neurosurgery. 36 (4): 839–841. doi:10.1227/00006123-199504000-00027. ISSN 0148-396X.