Atlantoaxial instability orthobullets. Diagnosis is made by dynamic CT scan of the cervical spine.
Atlantoaxial instability orthobullets. Follow Orthobullets on Social Media: INTRODUCTION A variety of terms have been used to describe a spectrum of rotational abnormalities of the atlantoaxial joint observed in the absence of major trauma, most commonly atlantoaxial rotatory displacement, atlanto-axial rotatory subluxation (AARS) and atlanto-axial rotatory fixation (AARF) [1 - 12]. Oct 13, 2024 · cervical collar immobilization (8-12 weeks) fracture patterns stable odontoid fractures atlantoaxial instability acute atlantoaxial rotatory displacement (AARD) stable subaxial cervical spine trauma thoracolumbosacral braces (8-12 weeks) Jan 5, 2019 · The atlantoaxial joint is the most mobile joint in the body. Surgical management is indicated in the presence of myelopathy, basilar invagination, or atlantoaxial instability. Aug 9, 2025 · Flexion and extension radiographs of cervical spine should be performed to evaluate for atlantoaxial instability. Jun 12, 2023 · Point of Care - Clinical decision support for Atlantoaxial Instability. Because of a large array of movements that originate from here, there is a larger possibility of the movements becoming abnormal, resulting in instability of the region. The atlantoaxial joint is the most mobile joint of the body. Our surgeons can discuss with you the various treatment options for your specific condition. The standing human posture and lifelong heartbeat like uninterrupted activity … The extreme instability of these inju-ries renders the position of the head relative to the neck completely arbitrary and more dependent on external forces Fig. Down's Syndrome Association There is little evidence in the literature that atlantoaxial asymmetry is associated with C1-C2 instability or (sub) luxation. Learn more here. Aug 19, 2025 · Evolving Technique: Atlanto-Axial Instability - Andrew Milby, MD Andrew Milby Emory University Orthopaedic Surgery Orthopaedic Summit Evolving Techniques 2024 The present study retrospectively evaluated 80 adults with Down syndrome for the presence of atlanto-occipital and atlantoaxial instability in lateral craniocervical radiographic images. Cervical CT is necessary to assess the atlantoaxial bony anatomy as well as to assess the foramen transversarium at C1 and C2. The functional result of the joint is two-fold: (1) providing support for the occiput and (2) providing the greatest range of Atlantoaxial Instability and C1 C2 Fusion 25 year old female complained of Neck Pain with tingling along neck and upper limbs . Diagnosis is made by dynamic CT scan of the cervical spine. Upper cervical instability in rheumatoid arthritis. Optimal management of atlantoaxial rotatory subluxation entails early diagnosis with plain cervical radiographs and dynamic computed tomography. In 2014, we reported the clinical entity of central or axial atlantoaxial instability (CAAD) wherein there was no radiological evidence of neural compression or of demonstrable instability according to the conventionally adopted radiological parameters [1]. Atlantoaxial rotatory subluxation is an isolated entity. This instability can originate from congenital conditions, but in adults, it is primarily seen in the setting of acute - cervical spine atlantoaxial instability may occur and is worked up in the usual manner (flexion and extension views); - atlantoaxial fusion is procedure of choice if instability causes symptoms; Nov 11, 2024 · Disability and instability of the unique atlantoaxial joint result in controversies regarding the management of acute trauma and also the screening evaluation of particular at-risk individuals. Sep 4, 2024 · Atlantoaxial instability (AAI) is characterized by excessive movement at the junction between the atlas (C1) and axis (C2) as a result of either a bony or a ligamentous abnormality. [1] Neurologic symptoms can occur when the spinal cord or adjacent nerve roots are involved. We obtained 282 radiographs of the cervical spine from a cohort of 400 children and young adults with Down's syndrome who attended special schools and who were between 4 and 20 years old Atlantoaxial Instability Three injury patterns, designated as A, B, and C, may occur either in isolation or in combination. Jun 12, 2023 · The atlantoaxial joint is the most mobile joint, with several critical neurovascular structures traversing through it. This activity describes the evaluation, diagnosis, and management of atlantoaxial instability and highlights the role of team-based interprofessional care for affected patients. Arthrodesis of the cervical spine in rheumatoid patients Occipitalization of the atlas Basilar Impression (Platybasia): A Bizarre Developmental Anomaly of the Occipital Bone and Upper Cervical Spine normal laboratory results McKusick type common associated with atlantoaxial instability secondary to odontoid hypoplasia ankle deformity due to fibular overgrowth associated with: abnormal immunocompetence We would like to show you a description here but the site won’t allow us. Defined as a pathological displacement of the atlantoaxial joint secondary to progressive AAI, AAD constitutes a severe disabling condition in spinal surgery. The purposes of this article are to define atlantoaxial instability (AAI); describe the relatively rare symptomatic lesions with significant morbidity Apart from diagnosis of instability on the basis of an increase in the atlantodental interval, atlantoaxial dislocation or instability can also be diagnosed on the basis of the align-ment of the facets of the atlas and axis [14, 15]. We identified CAAD with chronic or long Atlantoaxial Instability Three injury patterns, designated as A, B, and C, may occur either in isolation or in combination. Jun 16, 2021 · Down Syndrome is a common congenital disorder caused by the maternal duplication of chromosome 21. Objective Atlantoaxial dislocation (AAD) is a rare and potentially fatal disturbance to the normal occipital-cervical anatomy that affects some populations disproportionately, which may cause permanent neurologic The imaging findings of important CCJ injuries, such as atlanto-occipital dissociation, occipital condyle fractures, atlas fractures with transverse ligament rupture, atlantoaxial distraction, and traumatic rotatory subluxation, are important to recognize in the acute setting, often dictating patient management. Plain film radiographs of the cervical spine can be used to assess the atlantodental interval (ADI). Prototypical of disorders Apr 10, 2012 · Over the following weeks he developed weakness in his upper and lower extremities that evolved to the point that he lost his ability to ambulate, and was admitted to the public hospital in Managua, Nicaragua. Jan 13, 2025 · summary Atlantoaxial Rotatory Displacement is a pediatric cervical spine rotatory instability caused by C1-C2 subluxation or facet dislocation The most common presentation is a young child who presents with torticollis. Atlantoaxial instability was Fifteen patients with atlanto-axial instability (secondary to os odontoideum in three, nonunion of an odontoid fracture in seven, acute odontoid fracture in three, and rheumatoid arthirtis in two) were treated by wedge compression arthrodesis of the atlanto-axial joint. Atlantoaxial instability, also referred to as atlantoaxial subluxation, is defined as increased movement between the first (atlas) and second (axial) cervical vertebra joint articulation, the atlantoaxial joint. Apr 28, 2025 · Summary Occipitocervical instability can be traumatic or acquired through a degenerative process such as rheumatoid arthritis or Down syndrome Occipitocervical instability can be traumatic or acquired through a degenerative process such as rheumatoid arthritis or Down syndrome Diagnosis is usually confirmed with a combination of CT scan, MRI, and lateral flexion-extension radiographs Diagnosis Previous guidelines recommended cervical spine radiological screenings in preschool years to evaluate for atlantoaxial instability. Terminology Antlanto-axial rot Four broad categories of atlantoaxial problems were observed-atlantoaxial rotatory subluxation in six patients, anterior-posterior atlantoaxial instability caused by ligamentous injury or congenital ligamentous laxity (10 patients), atlantoaxial fracture with or without dislocation (five patients), and atlantooccipital dislocation (two patients). Considering the etiology for patients with AAD is important when selecting imaging approaches (8). In Type 3 atlantoaxial facetal instability, the facets are in alignment, and instability is assessed by telltale clinical and associated radiological evidence and is confirmed by direct manipulation of bones and identification of instability during surgery. Some children with Down syndrome also may have a condition known as Atlantoaxial Instability, a misalignment of the top two vertebrae of the neck. Four broad categories of atlantoaxial problems were observed-atlantoaxial rotatory subluxation in six patients, anterior-posterior atlantoaxial instability caused by ligamentous injury or congenital ligamentous laxity (10 patients), atlantoaxial fracture with or without dislocation (five patients), and atlantooccipital dislocation (two patients). In particular, CT scan should be used to estimate Understanding Atlantoaxial Instability Atlantoaxial (AAI) instability refers to a condition characterized by excessive movement between the atlas (C1) and axis (C2) vertebrae in the cervical spine. The aim of our study was to assess this presumed risk. 1 Artistic illustration of lateral (a) and posterior (b) views of the craniovertebral junction and the stabilizing ligaments. Oct 27, 2024 · Atlas fractures and transverse ligament injuries are traumatic injuries usually caused by high-energy trauma with axial loading in young patients (Jefferson fracture) or low-energy falls in the elderly. Atlanto-axial instability and spinal cord compression in children--diagnosis by computerized tomography. <br /><br />Imaging studies showed atlantoaxial instability from midsubstance transverse ligament tear. Patients present with mental retardation, cardiovascular abnormalities, cervical spine instability, generalized ligamentous laxity, and recurrent joint dislocations. In this episode, we review the high-yield topic of Atlantoaxial Instability from the Spine section. The purposes of this article are to define atlantoaxial instability (AAI); describe the relatively rare symptomatic lesions with significant morbidity Radiology Cases of Atlanto Axial Instability Lateral radiographs of the cervical spine show a mildly enlarged atlanto dens interval in neutral position (left), that increases significantly on flexion (center) and reduces on extension (right). Clinical symptoms and signs Here within, we present two patients treated with occipitocervical fusion for atlantoaxial instability and early symptoms of progressive myelopathy. Closed reduction with cervical traction followed by rigid immobilization accomplished reduction in 15 of 16 patients (94%) and was curative in 10 of 16 patients (63%). Oct 28, 2024 · The atlantoaxial joint is an important "transitional zone" in the cervical spine prone to instability by both degenerative and traumatic processes Jun 12, 2023 · The instability in this joint is usually congenital, but in adults, it may be due to an acute traumatic event or degenerative disease. Occipitocervical and Cervical Spine Instability Cervical spine instability, prima-rily of the upper cervical levels, is a concern in children with Down syn-drome. مجموعة كبيرة من الصور -Atlantoaxial Joint SubluxationObjective measurements of the atlantoaxial joint on radiographs performed without flexion can increase the confidence of diagnosis of atlantoaxial instability in toy breed dogs - Cummings - 2018 - Veterinary Radiology & Abstract There are a number of different imaging modalities that can be used to confirm atlantoaxial instability. This condition makes these children more prone to injury if they participate in activities which overextend or flex the neck. Patients presenting with neurological symptoms and cervical instability have increased postoperative rates of neurological complications and reoperations than patients with instability alone. J Bone Joint Surg [Am] 68:1289-1290, 1986 Dickman CA, Mamourian A. Asymmetry in odontoid-lateral mass interspace seems to occur occasionally in healthy individuals and patients suffering a cervical spine injury. See full list on boneandspine. arch causing atlanto-axial instability. She also had difficult in walking and urinary frequency. The physical architecture of the joint is characterized by a uniformly round and approximately flat surface, which allows a wide range of unobstructed movements. If suspected or borderline, perform neutral lateral, flexion lateral, and extension lateral radiographs of the cervical spine – if present, will reveal dynamic change in the atlantoaxial interval, indicating instability. Jul 13, 2022 · In this episode, we review the high-yield topic of Atlantoaxial Instability from the Spine section. Atlantoaxial Rotatory Displacement is a pediatric cervical spine rotatory instability caused by C1-C2 subluxation or facet dislocation Atlantoaxial Rotatory Displacement is a pediatric cervical spine rotatory instability caused by C1-C2 subluxation or facet dislocation The most common presentation is a young child who presents with torticollis. Conventionally, atlantoaxial instability has been diagnosed on the basis of abnormal alterations in the atlantodental interval and by radiological evidences of Sep 4, 2024 · Atlantoaxial instability (AAI) is characterized by excessive movement at the junction between the atlas (C1) and axis (C2) as a result of either a bony or ligamentous abnormality. Treatment depends on the location of the fracture within the C2 vertebrae defined by the Anderson and D'Alonzo classification system and the patient's risk factors for nonunion (failed bone healing). The standing human posture and lifelong Atlanto-axial instability (AAI) is common in the connective tissue disorders, such as rheumatoid arthritis, and increasingly recognized in the heritable disorders of Stickler, Loeys-Dietz, Marfan, Morquio, and Ehlers-Danlos (EDS) syndromes, where it typically presents as a rotary subluxation due to incompetence of the alar ligament. The functional result of the joi … Conventional surgical procedures for atlantoaxial instability or dislocation (AAI/D) have been associated with a high prevalence of postoperative occipitocervical pain and dysfunction, as well as substantial perioperative blood loss. Feb 11, 2020 · Physical Therapy Treatment of Atlantoaxial Joints Instability/Atlantoaxial Joints Instability or Atlantoaxial Dislocation refers to a loss of stability between the atlas and axis (C1–C2), resulting in loss of normal articulation. Sonntag VKH, Drayer BP: Mag- netic resonance imaging of the transverse atlantal ligament for the evaluation of atlantoaxial instability. Oct 26, 2024 · very rarely indicated type 3 with overt instability neural compression from displaced fracture fragment associated atlantooccipital or atlantoaxial injuries Techniques Occipitocervical fusion approach Atlantoaxial instability is associated with a longer dis-ease duration and those who demonstrate Jacod’s syn-drome, articular hypermobility, chronic renal failure, and elevated PTH levels. Thoracolumbar compression fractures are seen in pa-tients on chronic corticosteroid therapy. For patients with negative screening, re-screening was recommended if they wished to compete in the Special Olympics, or became symptomatic. The Apr 24, 2025 · Odontoid fractures are relatively common fractures of the C2 vertebral body (axis) that can be seen in low energy falls in eldery patients and high energy traumatic injuries in younger patients. Patients present with proportionate dwarfism, atlantoaxial instability, increased rate of carpal tunnel syndrome, cardiac abnormalities, mental retardation, and facial abnormalities. Although radiographic changes are common, the prevalence of neurologic injury is relatively low. While a successful surgery can result in rapid neurological recovery, any complication can be life-threatening. It may occur with or without an initiating trauma. Treatment and management. Further investigation into how Atlantoaxial instability is defined by an increase in the predentate space of greater then 3 mm in adults and 5 mm in children Symptoms will be present when the atlas moves far enough forward on the axis to narrow the spinal canal and impinge on the spinal cord Atlantoaxial instability (AAI) is subluxation or slippage of the first neck vertebrae in relation to the second. Nov 11, 2024 · Disability and instability of the unique atlantoaxial joint result in controversies regarding the management of acute trauma and also the screening evaluation of particular at-risk individuals. Objective Atlantoaxial dislocation (AAD) is a rare and potentially fatal disturbance to the normal occipital-cervical anatomy that affects some populations disproportionately, which may cause permanent neurologic deficits or sagittal deformity if not treated in a time … Spine High-Yield Topics Topics with the highest number of questions. [1]The atlantoaxial segment consists of the atlas (C1) and axis (C2) and forms a complex transitional structure bridging the occiput and cervical spine. Due to the capacious nature of the spinal canal at this level, these injuries usually present with neck pain without neurological deficits Atlantoaxial rotatory subluxation is a rare condition in which patients present with the acute onset of torticollis. The anterior facet of C1 is fixed on the facet of C2. The aim of this study was to audit the treatment of symptomatic atlantoaxial instability in Down syndrome and to assess factors associated with fusion failure in this group of patients. <br /><br />For additional imaging 10-40% of children with Down's syndrome have atlantoaxial instability. C1/2 instability may result from congenital malformation or syndromes, trauma, inflammatory arthritis, infection, malignancy deposits, osteoarthritic and some metabolic diseases. It may be associated with dislocation of the lateral mass of C1 on C2. Study Design Literature review. com Jun 2, 2025 · Basics Description Atlantoaxial instability (AAI) is the term for increased motion at the joint between the 1st and 2nd cervical vertebrae (the atlas and the axis). The cervical spine often becomes involved early in the course of rheumatoid arthritis, leading to three different patterns of instability: atlantoaxial subluxation, atlantoaxial impaction, and subaxial subluxation. A halo fixator can be used to achieve temporary reduction and stabilization of occipitoatlantal in-juries that likely will require sur-gery for definitive treatment (eg, traumatic atlantoaxial instability). This instability can occur not only at the atlantoaxial joint (C1-C2) but also at the occiput-C1 junction. It is more common in people with Down syndrome (DS) and there are unique screening considerations for people with DS compared to people without DS. Neurologic symptoms can occur when the spinal cord or adjacent nerve roots are involved. Atlanto-occipital instability was defined by the Rules of 12 or Harris measurements, using the values of the basion-dens interval or the basion-axial interval. This issue is mainly due to low muscle tone, loose ligaments, and alterations to the bone in patients with Down syndrome. Congenital, inflammatory, traumatic, or infectious conditions may weaken the structures supporting the C1–2 joint leading to atlantoaxial instability. We additionally provide a detailed review of the literature to inform practitioners of the spinal manifestations and clinical considerations in SEDC. METHODS The present study retrospectively evaluated 80 adults with Down syndrome for the presence of atlanto-occipital and atlantoaxial instability in lateral craniocervical radiographic images. Spinal fusion is indicated in patients with atlantoaxial instability, cervical myelopathy, or progressive scoliosis. Jan 16, 2024 · Treatment is usually observation with restriction of contact sports if the anomaly extends proximal to C2. The joint depends on the integrity of both the alar and transverse ligaments and the odontoid process for stability. Ligamentous laxity and joint hypermobility in these patients predispose them to atlantoaxial instability (AAI), which may progress to atlantoaxial dislocation (AAD) [3]. Jun 5, 2018 · Atlantoaxial instability (AAI) is characterized by excessive movement at the junction between the atlas (C1) and the axis (C2), as a result of either a bony or ligamentous abnormality. Atlantoaxial instability in Down's syndrome: a five year follow up study DS patients are at risk of atlanto‐axial instability (AAI) although AAI can occur in other conditions, such as rheumatoid arthritis, but this position statement deals specifically with DS patients and asymptomatic AAI. Atlantoaxial Instability Treatment Our surgeons provide a full range of treatments including non-surgical options as well as surgical repair. We would like to show you a description here but the site won’t allow us. The purposes of this article are to define atlantoaxial instability (AAI); describe the relatively rare symptomatic lesions with significant morbidity Surgery for atlantoaxial instability requires understanding of philosophical concepts apart from clarity of biomechanical and anatomical subtleties. Patients with Down syndrome have higher risks of developing atlantoaxial instability. DISCUSSION Instability of the atlantoaxial joint may arise because of congenital abnormalities, trauma, inflammation, infection, or neoplasm. Study Guide Acute Atlantoaxial Rotary Subluxation (AARS) Key Points: Also known as rotatory dislocation, displacement, or fixation Important to differentiate from congenital muscular torticollis Vast majority can be managed with non-operative treatment by observation or traction Description: Rotational subluxation or dislocation of C1 on C2 Can develop from osseous or ligamentous abnormalities Dec 29, 2023 · Atlantoaxial instability is generally associated with neural compression and related symptoms. The primary goal of treatment is to prevent permanent neurologic injury while Grisel's syndrome is a non-traumatic subluxation of the atlantoaxial joint following an inflammatory process in the upper respiratory tract. Often times if surgery is required, the bones between C1 and C2 are fused together, requiring less than 48 hours of an in-hospital stay. ABSTRACT 10-40% of children with Down's syndrome have atlantoaxial instability. Feb 9, 2025 · atlanto-axial subluxation: atlantoaxial rotatory fixation will cause C1 lateral mass asymmetry relative to the dens Down syndrome: atlanto-occipital instability due to laxity of the alar ligament rheumatoid arthritis: CT/MRI will show atlantooccipital instability due to pannus destabilisation of joints and ligaments, and x-ray will show erosions Atlantoaxial instability is defined by an increase in the predentate space of greater then 3 mm in adults and 5 mm in children Symptoms will be present when the atlas moves far enough forward on the axis to narrow the spinal canal and impinge on the spinal cord Sep 19, 2024 · atlantoaxial instability chronic atlantoaxial rotatory displacement (AARD) Prognosis Mortality higher mortality rate at C3 or above injuries at C1 lead to a mortality rate of 17% injuries at C4 lead to a mortality rate of ~4% Neurologic injury spinal cord injury is more common/lethal in patients younger than 8 y/o 8. Atlanto-axial instability Definition Loss of ligamentous stability between atlas and axis Can cause impingement of the spinal cord Etiology Down's syndrome - combination of ligamentous laxity, ondontoid dysplasia & os odontoid Rheumatoid arthritis - attrition of transverse ligament and ondontoid erosion Ligamentous laxity - Marfan's, Larsen's Atlantoaxial instability, also referred to as atlantoaxial subluxation, is defined as increased movement between the first (atlas) and second (axial) cervical vertebra joint articulation, the atlantoaxial joint. The atlantoaxial joint is the most mobile joint in the body. The atlantoaxial segment consists of the atlas (C1) and axis (C2) and forms a complex transitional structure bridging the occiput and cervical spine. We hypothesized that minimally invasive surgery for posterior atlantoaxial lateral mass joint fusion (MIS-PALF), a procedure that can largely avoid disruption of Jun 29, 2025 · Mucopolysaccharidoses are a group of 13 metabolic syndromes caused by the absence or malfunctioning of lysosomal enzymes which break down glycosaminoglycans. Jun 22, 2024 · Spine⎪Atlantoaxial Instability orthobullets podcast June 22, 2024 by orthobullets May 15, 2025 · Atlanto-axial rotary fixation is a disorder of C1-C2 causing impairment in neck rotation. Treatment involves a multidisciplinary approach to improve and maintain function. This study detailed global complication rates of posterior arthrodesis for DS patients, identifying bony-related complications and reoperations among the most common. Spine fusion for atlanto-axial instability. If left untreated, some cases may resolve spontaneously; however, other cases may result in the development of secondary Introduction Atlantoaxial instability (AAI) occurs as a result of trauma, congenital conditions such as os odontoideum, neoplasm, infection and degenerative connective tissue disorders such as rheumatoid arthritis, genetic conditions such as HOX-D3 and Down syndrome, and heritable connective tissue disorders, emblematic of which are the Ehlers Danlos syndromes (EDS). Jun 25, 2021 · Rheumatoid Cervical Spondylitis comprises of 3 specific patterns of cervical spine instability seen in rheumatoid arthritis that consist of atlantoaxial subluxation, basilar invagination, and subaxial subluxation. Cranial subluxation of the odontoid process in rheumatoid arthritis. This instability can lead to compression of the spinal cord or nerve roots. 3- to 11-year followup of occipitocervical fusion for rheumatoid arthritis. . These children might run the risk of spinal cord compression if they play sport. Atlantoaxial rotatory subluxation represents a spectrum of disease from muscle spasm to a fixed mechanical block to reduction of the atlantoaxial complex. In 1986 all 90 children aged 4-19 years with Down's syndrome attending school in the area served by the Southern Derbyshire Health Authority underwent radiography to identify atlantoaxial instability (AAI). Early diagnosis and treatment are vital for patients. Introduction, Etiology, Epidemiology, Pathophysiology, History and Physical, Evaluation, Treatment / Management, Differential Diagnosis, Staging, Prognosis, Complications, Postoperative and Rehabilitation Care, Consultations, Deterrence and Patient Education, Pearls and Other Issues, Enhancing Jul 1, 2025 · Looseness and instability of the ligaments around the atlantoaxial joint and normal bone and ligament structure broken by the tumor all lead to AAD (7). Thin-section CT is most sensitive and specific for associated fractures. Atlanto-axial fusion for instability. pqk7pjfm4y55vfavtf9mpevu4jpwcrhimu2cgudpofdwf