Modern diagnosis and therapy of children atlanto-axial subluxation / 中国矫形外科杂志

[Objective] To study the diagnosis and treatment of children atlanto-axial subluxation(CAAS).[Method]The clinical and pre-and posttreatment imaginological materials of 24 CAAS were reviewed and analyzed.There were 13 males and 11 females with average age 7.8 years(range:8 months-16 years).Pre-and posttreatment mouth-open cervical anterior-posterior and lateral X-ray films were taken for all cases,cervical 3D-CT and MRI were made if needed.Lateral and rotational displacement of CAAS could reveal in mouth-open cervical anterior-posterior radiographs,while thickness of post-pharyngeal soft tissue could show in lateral X-ray films.Simple fixation with neck band and analgesic were used to treat cases with mild neck pain and torticollis less than 1 week.Mandibulooccipital belt traction and analgesic were taken for treatment of the cases with sign and symptom more than 1 week.For cases with anterior displacement,the displacement should be reduced then immobilized with head trunk cast or brace for 6 weeks.Cases with symptoms lasted for 1-3 months should be treated with halo-torse plastic vest traction.And atlanto-axial fusion should be applied for cases with symtoms lasting more than 3 months.[Result]All cases were followed-up for 8 months to 2 years with average 1 year 4 months.Post-treatment radiographs showed odentoid process of axis centrally located and a normal bilateral atlas-dens intervals,as well as CT scanning revealed normal axial anterior space.There were normal cervical motion without residual deformity and no recurrence of CAAS.[Conclusion]Mouth-open anterior-posterior radiograph is an ideal measure for early diagnosis of CAAS and CT scanning is choiceable for doubtful cases.Non-surgical treatment is main therapy for CAAS while posterior bone graft fusion of atlanto-axial joint is selective method for non-reducible cases.

Vertebral Artery Obstruction due to Anterior and Vertical Subluxation of Atlanto-Axial and Atlanto-Occipital Joint in Ankylosing Spondylitis

OBJECTIVE: We report a case with a long-standing history of the ankylosing spondylitis(AS) who showed multiple cerebellar infarctions with bulbar symptom owing to vertebral artery obstruction, due to anterior and vertical subluxation of atlanto-axial and atlanto-occipital joint. CLINICAL PRESENTARION: An 51-year-old male patient with swallowing difficulty, tongue deviation to the left side and severe nuchal pain and rigidity is presented. INTERVENTION: After removal of posterior portion of foramen magnum, posterior portion of left transverse foramen of axis was decompressed. CONCLUSIONS: Spontaneous anterior atlanto-axial subluxation occurs in patients with AS about 2% of presents with or without signs of spinal cord compression. Vertical subluxation occurs in 3-8% of patient with rheumatoid arthritis but it is an exceedingly rare complication of AS. Close observation and follow-up are needed in patients with AS and if subluxation occurs, good prognosis is anticipated using an early operative treatment.

One-stage Transoral Decompression and Posterior Fusion in Rheumatoid Atlanto-axial Subluxation: Report of A Case

Authors report a case of one-stage transoral decompression and posterior fusion in rheumatoid atlanto-axial subluxation. A 63-year-old man developed a rheumatoid atlantoaxial subluxation with mild weakness of all extremities which developed relatively suddenly 3 motnths after the initial symptom of neck pain. Skeletal traction followed by transoral decompression and occipitocervical fusion was performed on the same day. Postoperative course has been uneventful and revealed favorable fusion state of occipito-atlanto-axis. The pertinent literature on rheumatoid atlanto-axial subluxation is reviewed and discussed.

One-stage Transoral Decompression and Posterior Fusion in Rheumatoid Atlanto-axial Subluxation: Report of A Case

Authors report a case of one-stage transoral decompression and posterior fusion in rheumatoid atlanto-axial subluxation. A 63-year-old man developed a rheumatoid atlantoaxial subluxation with mild weakness of all extremities which developed relatively suddenly 3 motnths after the initial symptom of neck pain. Skeletal traction followed by transoral decompression and occipitocervical fusion was performed on the same day. Postoperative course has been uneventful and revealed favorable fusion state of occipito-atlanto-axis. The pertinent literature on rheumatoid atlanto-axial subluxation is reviewed and discussed.