• Title, Summary, Keyword: Atlantoaxial joint

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Atlantoaxial Joint Syndrome Misconceived as an Idiopathic Neuralgia -A case report- (특발성 신경통으로 오인된 환축추관절 증후군 -증례 보고-)

  • Hong, Seong Joon;Lee, Jeong Beom;Jung, Seung Won;Kim, II Seok;Lim, So Young;Shin, Keun Man
    • The Korean Journal of Pain
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    • v.18 no.1
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    • pp.48-51
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    • 2005
  • Although the atlantoaxial joint is the most common site of rheumatoid arthritis, our patient had no symptoms or signs suggestive of rheumatoid arthritis. The atlantoaxial joint is frequently involved in degenerative osteoarthritis, especially in elderly patients. An 81-year old man presented with severe intermittent electric shock like, lancinating pain from the occipital to the temporal and parietofrontal areas. He also had neck pain and a limited range of motion. After many examinations and laboratory tests, at the department of neurology and neurosurgery, he was diagnosed with idiopathic neuralgia. The diagnosis of atlantoaxial joint syndrome was confirmed, and treated successfully with atlantoaxial joint block.

Surgical Treatment of the Atlantoaxial Osteoarthritis

  • Jin, Kwang-Ouk;Kim, Young-Woo;Rim, Dae-Cheol;Ahn, Sung-Ki
    • Journal of Korean Neurosurgical Society
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    • v.41 no.4
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    • pp.264-266
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    • 2007
  • Atlantoaxial facet joint osteoarthritis is rare, often undiagnosed because it may be misdiagnosed as occipital neuralgia, or degenerative cervical spondylosis. Unilateral occipitocervical pain aggravated by head rotation is a specific symptom. Conservative treatment is usually effective. But when the patient complains of intractable neck pain localized to occipitocervical junction and unresponsive to medical therapy, surgical treatment should be considered. Though a few reports of surgically treated atlantoaxial osteoarthritis has been published, surgical outcome is favorable. A case of a surgically treated atlantoaxial osteoarthritis is presented with a review of the literatures.

Risk Factors for the Development and Progression of Atlantoaxial Subluxation in Surgically Treated Rheumatoid Arthritis Patients, Considering the Time Interval between Rheumatoid Arthritis Diagnosis and Surgery

  • Na, Min-Kyun;Chun, Hyoung-Joon;Bak, Koang-Hum;Yi, Hyeong-Joong;Ryu, Je Il;Han, Myung-Hoon
    • Journal of Korean Neurosurgical Society
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    • v.59 no.6
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    • pp.590-596
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    • 2016
  • Objective : Rheumatoid arthritis (RA) is a systemic disease that can affect the cervical spine, especially the atlantoaxial region. The present study evaluated the risk factors for atlantoaxial subluxation (AAS) development and progression in patients who have undergone surgical treatment. Methods : We retrospectively analyzed the data of 62 patients with RA and surgically treated AAS between 2002 and 2015. Additionally, we identified 62 patients as controls using propensity score matching of sex and age among 12667 RA patients from a rheumatology registry between 2007 and 2015. We extracted patient data, including sex, age at diagnosis, age at surgery, disease duration, radiographic hand joint changes, and history of methotrexate use, and laboratory data, including presence of rheumatoid factor and the C-reactive protein (CRP) level. Results : The mean patient age at diagnosis was 38.0 years. The mean time interval between RA diagnosis and AAS surgery was $13.6{\pm}7.0$ years. The risk factors for surgically treated AAS development were the serum CRP level (p=0.005) and radiographic hand joint erosion (p=0.009). The risk factors for AAS progression were a short time interval between RA diagnosis and radiographic hand joint erosion (p<0.001) and young age at RA diagnosis (p=0.04). Conclusion : The CRP level at RA diagnosis and a short time interval between RA diagnosis and radiographic hand joint erosion might be risk factors for surgically treated AAS development in RA patients. Additionally, a short time interval between RA diagnosis and radiographic hand joint erosion and young age at RA diagnosis might be risk factors for AAS progression.

Vertical Reduction Using Atlantoaxial Facet Spacer in Basilar Invagination with Atlantoaxial Instability

  • Kim, Il-Sup;Hong, Jae-Taek;Sung, Jae-Hoon;Byun, Jae-Hoon
    • Journal of Korean Neurosurgical Society
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    • v.50 no.6
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    • pp.528-531
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    • 2011
  • Although posterior segmental fixation technique is becoming increasingly popular, surgical treatment of craniovertebral junctional disorders is still challenging because of its complex anatomy and surrounding critical neurovascular structures. Basilar invagination is major pathology of craniovertebral junction that has been a subject of clinical interest because of its various clinical presentations and difficulty of treatment. Most authors recommend a posterior occipitocervical fixation following transoral decompression or posterior decompression and occipitocervical fixation. However, both surgical modalities inadvertently sacrifice C0-1 and C1-2 joint motion. We report two cases of basilar invagination reduced by the vertical distraction between C1-2 facet joint. We reduced the C1-2 joint in an anatomical position and fused the joint with iliac bone graft and C1-2 segmental fixation using the polyaxial screws and rods C-1 lateral mass and the C-2 pedicle.

Posterior Atlantoaxial Transarticular Screw Fixation

  • Ko, Byung-Su;Lee, Jung-Kil;Kim, Yeon-Seong;Moon, Sung-Jun;Kim, Jae-Hyoo;Kim, Soo-Han
    • Journal of Korean Neurosurgical Society
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    • v.42 no.3
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    • pp.179-183
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    • 2007
  • Objective : Posterior arthrodesis in atlantoaxial instability has been performed using various posterior C1-2 wiring techniques. Recently, transarticular screw fixation (TASF) technique was introduced to achieve significant immediate stability of the C1-2 joint complex. The purpose of this study is to assess the clinical outcomes associated with posterior C1-2 TASF for the patient of atlantoaxial instability. Methods : We retrospectively reviewed data obtained from 17 patients who underwent C1-2 TASF and supplemented Posterior wiring technique (PWT) with graft between 1994 and 2005. There were 8 men and 9 women with a mean age of 43.5 years (range, 12-65 years). An average follow-up was 26 months (range, 15-108 months). Results : Successful fusions were achieved in 16 of 17 (94%). The pain was improved markedly (3 patients) or resolved completely (14 patients). There was no case of neurological deterioration, hypoglossal nerve injury, or vertebral artery injury. Progression of spinal deformity, screw pullout or breakage, and neurological or vascular complications did not occur. Conclusion : The C1-2 TASF with supplemental wiring provided a high fusion rate. Our result demonstrates that C1-2 TASF supplemented by PWT is a safe and effective procedure for atlantoaxial instability. Preoperative evaluation and planning is mandatory for optimal safety.

Successful Treatment of Occipital Radiating Headache Using Pulsed Radiofrequency Therapy

  • Lee, Sun Yeul;Jang, Dae Il;Noh, Chan;Ko, Young Kwon
    • Journal of Korean Neurosurgical Society
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    • v.58 no.1
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    • pp.89-92
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    • 2015
  • Rheumatoid arthritis (RA) is a chronic inflammatory disease involving multiple joints. The cervical spine is often affected, and cases involving atlantoaxial joint can lead to instability. Anterior atlantoaxial subluxation in RA patients can lead to posterior neck pain or occipital headache because of compression of the C2 ganglion or nerve. Here, we report the successful treatment of a RA patient with occipital radiating headache using pulsed radiofrequency therapy at the C2 dorsal root ganglion.

Comparison of Outcomes after Atlantoaxial Fusion with Transarticular Screws and Screw-Rod Constructs

  • Kim, Ji Yong;Oh, Chang Hyun;Yoon, Seung Hwan;Park, Hyeong-Chun;Seo, Hyun Sung
    • Journal of Korean Neurosurgical Society
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    • v.55 no.5
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    • pp.255-260
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    • 2014
  • Objective : The purpose of this study was to compare the radiological and neurological outcomes between two atlantoaxial fusion method for atlantoaxial stabilization; C1 lateral mass-C2 pedicle screws (screw-rod constructs, SRC) versus C1-2 transarticular screws (TAS). Methods : Forty-one patients in whom atlantoaxial instability was treated with atlantoaxial fixation by SRC group (27 patients, from March 2005 to May 2011) or TAS group (14 patients, from May 2000 to December 2005) were retrospectively reviewed. Numeric rating scale (NRS) for pain assessment, Oswestry disability index (ODI), and Frankel grade were also checked for neurological outcome. In radiologic outcome assessment, proper screw position and fusion rate were checked. Perioperative parameters such as blood loss during operation, operation time, and radiation exposure time were also reviewed. Results : The improvement of NRS and ODI were not different between both groups significantly. Good to excellent response in Frankel grade is shown similarly in both groups. Proper screw position and fusion rate were also observed similarly between two groups. Total bleeding amount during operation is lesser in SRC group than TAS group, but not significantly (p=0.06). Operation time and X-ray exposure time were shorter in SRC group than in TAS group (all p<0.001). Conclusion : Both TAS and SRC could be selected as safe and effective treatment options for C1-2 instability. But the perioperative result, which is technical demanding and X-ray exposure might be expected better in SRC group compared to TAS group.

Atlantoaxial Stabilization Using C1 and C2 Laminar Screw Fixation

  • Tsuji, Takashi;Chiba, Kazuhiro;Horiuchi, Yosuke;Urabe, Tadahisa;Fujita, Shota;Matsumoto, Morio
    • Asian Spine Journal
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    • v.11 no.2
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    • pp.314-318
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    • 2017
  • We describe the use of a C1 laminar screw in combination with a C2 laminar screw as a salvage technique to treat two patients, one with persistent first intersegmental artery and the other with vertebral artery occlusion after cervical spine fracture. The combined use of C1 and C2 laminar screws allows for good fixation of the atlantoaxial joint with a lower risk of vertebral artery injury; therefore, it can be an alternative surgical procedure for patients with congenital or traumatic anomalous vertebral artery.

Posterior Atlantoaxial Screw-Rod Fixation in a Case of Aberrant Vertebral Artery Course Combined with Bilateral High-Riding Vertebral Artery

  • Park, Young-Seop;Kang, Dong-Ho;Park, Kyung-Bum;Hwang, Soo-Hyun
    • Journal of Korean Neurosurgical Society
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    • v.48 no.4
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    • pp.367-370
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    • 2010
  • We present a case of posterior atlantoaxial screw-rod fixation in a patient with an aberrant vertebral artery (VA) course combined with bilateral high-riding VA. An aberrant VA which courses below the posterior arch of the atlas (C1) that does not pass through the C1 transverse foramen and without an osseous anomaly is rare. However, it is important to consider an abnormal course of the VA both preoperatively and intraoperatively in order to avoid critical vascular injuries in procedures which require exposure or control of the VA, such as the far-lateral approach and spinal operations.