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The neck
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Anomalies of the odontoid are more common in patients with Down’s syndrome, Klippel–Feil syndrome, multiple epiphyseal dysplasia and other skeletal dysplasia, and they should be suspected in this setting. This is especially important in patients undergoing operation, as the atlantoaxial joint may subluxate during general anaesthetic procedures.
Atlantoaxial instability
Published in Benjamin Joseph, Selvadurai Nayagam, Randall Loder, Ian Torode, Paediatric Orthopaedics, 2016
Children with a Grisel’s syndrome should be treated as an emergency with stabilisation using a halo and traction under close observation. The definitive treatment is a posterior fusion of C1 and C2. If there is an accompanying myelopathy careful documentation is required followed by an attempted reduction. The best decompression is by reduction of the subluxation or dislocation. It may be necessary to perform an open reduction by a lateral approach to the atlantoaxial joint.10 An alternative approach is by anterior transoral release of the dislocated and fixed atlantoaxial joint followed by posterior fixation and fusion of C1 and C2.11
The movement systems: skeletal and muscular
Published in Nick Draper, Helen Marshall, Exercise Physiology, 2014
The different types of synovial joint are shown in Figure 5.6. Gliding joints, such as between the vertebrae in the spine or the sternoclavicular joint as illustrated, are formed when the flat surfaces of bones come together. The amount of movement in a gliding joint is minimal. The elbow, knee and ankle are examples of hinge joints that enable flexion and extension of the arm and leg along with dorsiflexion and plantar flexion of the foot. The atlanto-axial joint in the spine is an example of a pivot joint which enables the head to rotate and is formed between the odontoid peg or dens of the axis bone and the ring of the atlas. An example of ellipsoid or condyloid joints can be found between the arm and hand at the wrist which are called the radiocarpal joints. The wrist enables movement in two planes and is formed where a convex surface fits in to a concave surface.
Vertebro-basilar stroke due to Bow-Hunter syndrome: an unusual presentation of rotatory atlanto-axial subluxation in a fourteen year old
Published in British Journal of Neurosurgery, 2023
A 14-year-old male presented with sudden onset vertigo and imbalance while walking. Examination found slurring of speech, severe ataxia, and nystagmus with normal vision, power and sensations. He had a mild torticollis present since childhood, but never investigated. MRI of the brain revealed areas of diffusion restriction in the bilateral cerebellum and occipital lobes (Figure 1). MR angiography revealed a hypoplastic left vertebral artery and kinking of the right vertebral artery near the cranio-vertebral junction (Figure 2, 3). CT and MRI scan of the cervical spine revealed rotatory subluxation of the right atlanto-axial joint with aplasia of the right C1 arch and occipitalisation of the left C1 arch (Figures 4 and 5). He was treated by C1 lateral mass to C2 subfacetal screw and rod fixation.
Bow hunter’s syndrome after cervical laminoplasty in a patient with rheumatoid arthritis with bony ankylosis in the cervical spine: a case report
Published in Modern Rheumatology Case Reports, 2020
Sho Dohzono, Ryuichi Sasaoka, Kiyohito Takamatsu, Hiroaki Nakamura
Cervical laminoplasty for patients with cervical bony ankyloses can led to rotational spinal instability. RA often affects the cervical spine, as well as the hand and wrist joints, and the prevalence of bony ankyloses of the cervical spine is reportedly 9–26% [8–10]. Biomechanically, the atlantoaxial joint is the most rotatable joint in the cervical spine, with a normal range of rotation of 40–45° [20,21]. The present patient had bony ankyloses at the atlantoaxial joint and the C4–C5 facet joints before laminoplasty, and the C3 vertebral posterior slippage deteriorated and osteosclerosis appeared at the C3–C4 vertebrae after laminoplasty. Therefore, rotational mechanical stress on the C3 vertebra, which was the segment adjacent to the ankylosed joints, may increase after cervical laminectomy at C3 with C4–C7 laminoplasty.
Unilateral lag screw fixation of isolated non-union atlas lateral mass fracture: a new technical note
Published in British Journal of Neurosurgery, 2019
Majid Reza Farrokhi, Arash Kiani, Hamid Rezaei
Atlas fractures are usually stable which can also be unstable if they are associated with atlantoaxial ligamentous complex injury that may necessitate surgical intervention. Various conditions such as trauma, arthritis, infection or congenital malformations could make the atlantoaxial joint unstable.11,13 If cervical spinal column injuries are treated improperly, they could cause chronic pain, limitation of motion and even cervical cord injuries resulting in severe neurological impairment. The lateral mass screw fixation of atlas is a well-known described technique.19,20 This procedure is usually being performed bilaterally in combination with C2 pedicular screw fixation,21 resulting in favorable fusion outcomes. There are no reports of unilateral lag screw fixation of atlas lateral mass fracture in the literature. In this report, we successfully fixed the lateral mass fracture of atlas via a single lag screw using standard posterior approach. An important point in this study was that the distance between the fracture’s edges was significant and thus spontaneous healing and fusion could not be achieved even after immobilization. Using a lag screw provided us with the ability to successfully reduce and approximate the fracture’s edges. Considering the large fracture gap, the screw had to be inserted in full length so that the gap could be totally reduced that caused 3 mm extrusion of the screw’s tip from the anterior border of atlas.