RESUMO
ABSTRACT Traumatic atlanto-axial subluxation is a rare and underdiagnosed condition due to its high rate - reported to be between 60 and 80% - of early mortality. Its diagnosis takes into account the trauma mechanism, precise analyses of the imaging tests and the clinical presentation of the patient. This article describes a rare presentation of atlanto-axial subluxation associated with craniocervical dislocation as a case of locked-in syndrome. Level of evidence V; Retrospective observational study - Case report.
RESUMO Subluxação atlantoaxial traumática é uma condição de diagnóstico raro e subestimado, devido a sua alta taxa - descrita entre 60% e 80% - de mortalidade precoce. Seu diagnóstico leva em conta o mecanismo do trauma, as análises precisas dos exames de imagem e a apresentação clínica do paciente. Este artigo relata um quadro raro de subluxação atlantoaxial associada à luxação craniocervical como um caso de síndrome do encarceramento. Nível de evidência V; Estudo observacional retrospectivo - Relato de caso.
RESUMEN La subluxación atlantoaxoidea traumática es una afección rara y subdiagnosticada debido a su alta tasa - descrita entre el 60 y el 80%-de mortalidad temprana. Su diagnóstico tiene en cuenta el mecanismo del traumatismo, los análisis de imagen precisos y la presentación clínica del paciente. Este artículo informa de una rara condición de subluxación atloaxoidea asociada a una dislocación craniocervical como un caso de síndrome de enclaustramiento. Nivel de evidencia V; Estudio observacional retrospectivo - Informe de caso.
Assuntos
Traumatismos do Sistema Nervoso , Coluna Vertebral , Fraturas da Coluna VertebralRESUMO
OBJECTIVE: The purpose of this study is to evaluate the clinical and radiographic results of infective atlantoaxial subluxation, and to describe the management of pyogenic or tuberculosis atlantoaxial subluxation. METHODS: In this study, we present seven patients with atlantoaxial subluxation after pyogenic or tuberculosis vertebral osteomyelitis. Prominent manifestations included neck pain and stiffness, swelling of the retropharyngeal soft tissues, quadriparesis, and osteolytic erosions. All patients received antibiotics/antituberculosis medication. One patient was managed conservatively, two underwent only transoral biopsy, one patient underwent transoral decompression and posterior fusion, and three patients underwent only posterior fusion. RESULTS: All patients showed significant improvement in neck pain and neck movement. Three patients who showed quadriparesis or motor weakness at the time of diagnosis showed improvement in motor strength, although subjective weakness persisted in two patients. CONCLUSION: In our study, we describe the management of this disease at our institute. Available treatment modalities vary from purely conservative medical management to surgical correction. Medical treatment is the mainstay of management. The need for and the extent of surgery are dependent on the presence of instability and spinal cord compression and should be determined on a case by case basis.