• Title/Summary/Keyword: Atlantoaxial joint

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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.

Effect of Manual Therapy on a Patient With Atlantoaxial Rotatory Subluxation (환축추 회전 아탈구 환자에 대한 도수치료 효과)

  • Jeon, Jae-guk;Yang, Seong-hwa;Shin, Eui-ju
    • The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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    • v.25 no.1
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    • pp.71-76
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    • 2019
  • Background: An 8-year-old girl had severe neck pain and stiffness after trauma. CT scan showed atlantoaxial rotatory subluxation (AARS). She had conservative treatment because she did not have neurological symptoms and spinal basilar artery dysfunction. Conservative therapy was halter traction twice for 4 weeks. However, pain and stiffness persisted. She had been recommended to have surgery from her physician, but she received manual therapy for non-surgical procedures. Methods: The joint mobilization, muscle energy technique, motor control exercise, and deep neck flexor (DNF) endurance exercise were applied as manual therapy and 10 session for 2weeks. Results: Clinical outcomes were measured at initial baseline, after 2 weeks, and after 6weeks. Active range of motion was completely restored after 6weeks and numeric pain rating scale was completely reduced after 2 weeks. The strength of neck flexor muscle recovered to normal after 2 weeks, and the DNF endurance was improved to 25 seconds after 2 weeks and to 42 seconds after 6weeks. Motor control capacity recovered to 30 ㎜Hg after 2 weeks. Conclusions: This case report describes the immediate and short-term clinical outcomes for a patient presenting with symptoms of neck pain following AARS. Clinical rationale and patient preference aided the decision to incorporate manual therapy as a treatment for this patient. Manual therapy has shown a successful recovery in AARS patients, more research is needed to validate the inference of this case report.

Atlantoaxial Rotatory Fixation in Adults Patient

  • Jeon, Sei-Woong;Jeong, Je-Hoon;Moon, Seung-Myung;Choi, Sun-Kil
    • Journal of Korean Neurosurgical Society
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    • v.45 no.4
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    • pp.246-248
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    • 2009
  • Atlantoaxial rotatory fixation (AARF) in adult is a rare disorder that occurs followed by a trauma. The patients were presented with painful torticollis and a typical 'cock robin' position of the head. The clinical diagnosis is generally difficult and often made in the late stage. In some cases, an irreducible or chronic fixation develops. We reported a case of AARF in adult patient which was treated by immobilization with conservative treatment. A 25-year-old female was presented with a posterior neck pain and limitation of motion of cervical spine after a traffic accident. She had no neurological deficit but suffered from severe defect on the scalp and multiple thoracic compression fractures. Plain radiographs demonstrated torticollis, lateral shift of odontoid process to one side and widening of one side of C1-C2 joint space. Immobilization with a Holter traction were performed and analgesics and muscle relaxants were given. Posterior neck pain and limitation of the cervical spine' motion were resolved. Plain cervical radiographs taken at one month after the injury showed that torticollis disappeared and the dens were in the midline position. The authors reported a case of type I post-traumatic AARF that was successfully treated by immobilization alone.

Ventral Fixation of Atlantoaxial Joint under Fluoroscopic Guidance Using Screws in a Chihuahua Dog (환축추 아탈구 견에서 투시기 유도를 통한 복측 나사 고정술)

  • Lee, Jae-Hoon;Yang, Hee-Taek;Yang, Wo-Jong;Chung, Dai-Jung;Kang, Eun-Hee;Eom, Ki-Dong;Choi, Chi-Bong;Chang, Hwa-Seok;Kim, Hwi-Yool
    • Journal of Veterinary Clinics
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    • v.25 no.2
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    • pp.131-135
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    • 2008
  • A 5-year-old Chihuahua dog was evaluated for a tetraparesis. The dog was presented with a non-ambulatory tetraparesis and neck pain. Radiography demonstrated an atlantoaxial (AA) subluxation and increased distance between the dorsal arch of the C1 and the dorsal spinous process of the C2. The AA joint was fixed with ventral transarticular fixation using two screws under fluoroscopic guidance. Neck brace was applied during 3 weeks post-operation. After 4 weeks, the dog was fully ambulatory with improved neurological function. Postoperative radiographs confirmed reduction of the luxation and no migration of screws. The dog showed complete resolution of clinical signs without signs of recurrence till 4 months after operation. Proper angulations of screws provided under fluoroscopic guidance, enabled adequate stabilization of the AA joints using ventral transarticular screw fixation which improved neurologic outcome of the patient.

Interpretation and Generalization by Neuroscience and Material Mechanics on Deviation in Temporomandibular Joint Balancing Medicine (턱관절균형의학에서 편차발생현상의 신경과학 및 재료역학적 해석과 일반화)

  • Gyoo-yong Chi
    • Journal of TMJ Balancing Medicine
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    • v.12 no.1
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    • pp.1-6
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    • 2022
  • Objectives: For the deviation phenomenon occurring during the treatment process in temporo-mandibular balancing medicine (TBM), hypotheses were established regarding the cause and mechanism of formation from the perspective of neuro-science and material mechanics, and a verification method was proposed. Methods: The deviation phenomenon was theoretically analyzed based on the structure theories of material mechanics of the joint and the neurological pain mechanism. Results: Deviation occurs due to temporary yield by the accumulation of heterogeneous stress in the temporo-mandibular joint and the affected joint. Because the joint structures are corresponding with material mechanics showing compressive and tensile properties. The size of the deviation is expressed in terms of strain. The occlusal surface of the teeth is level with the axial joint. Since the magnitude of the deviation has a proportional relationship with the degree of abnormality of the temporo-mandibular joint, the magnitude of the deviation calculated by the balance measurement can be replaced by the strain. The major variables involved in the occurrence of deviations are the strength of joint structures and neurological conditions. Therefore plastic deformation and adaptation occur as a long-term depression of neural circuits is strengthened in different ways at different locations each time in various clinical situations. This is the reason why the sequence of the restoration process while correcting deviations is following reverse order of the accumulation in many layers in the muscular nervous system. Conclusions: From the above results, it can be inferred that the occurrence and correction of the deviations are corresponding with the plastic deformation and neuro-plasticity.

Additional Surgical Method Aimed to Increase Distractive Force during Occipitocervical Stabilization : Technical Note

  • Antar, Veysel;Turk, Okan
    • Journal of Korean Neurosurgical Society
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    • v.61 no.2
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    • pp.277-281
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    • 2018
  • Objective : Craniovertebral junctional anomalies constitute a technical challenge. Surgical opening of atlantoaxial joint region is a complex procedure especially in patients with nuchal deformity like basilar invagination. This region has actually very complicated anatomical and functional characteristics, including multiple joints providing extension, flexion, and wide rotation. In fact, it is also a bottleneck region where bones, neural structures, and blood vessels are located. Stabilization surgery regarding this region should consider the fact that the area exposes excessive and life-long stress due to complex movements and human posture. Therefore, all options should be considered for surgical stabilization, and they could be interchanged during the surgery, if required. Methods : A 53-year-old male patient applied to outpatients' clinic with complaints of head and neck pain persisting for a long time. Physical examination was normal except increased deep tendon reflexes. The patient was on long-term corticosteroid due to an allergic disease. Magnetic resonance imaging and computed tomography findings indicated basilar invagination and atlantoaxial dislocation.The patient underwent C0-C3-C4 (lateral mass) and additional C0-C2 (translaminar) stabilization surgery. Results : In routine practice, the sites where rods are bound to occipital plates were placed as paramedian. Instead, we inserted lateral mass screw to the sites where occipital screws were inserted on the occipital plate, thereby creating a site where extra rod could be bound.When C2 translaminar screw is inserted, screw caps remain on the median plane, which makes them difficult to bind to contralateral system. These bind directly to occipital plate without any connection from this region to the contralateral system.Advantages of this technique include easy insertion of C2 translaminar screws, presence of increased screw sizes, and exclusion of pullout forces onto the screw from neck movements. Another advantage of the technique is the median placement of the rod; i.e., thick part of the occipital bone is in alignment with axial loading. Conclusion : We believe that this technique, which could be easily performed as adjuvant to classical stabilization surgery with no need for special screw and rod, may improve distraction force in patients with low bone density.

Inferolateral Entry Point for C2 Pedicle Screw Fixation in High Cervical Lesions

  • Lee, Kwang-Ho;Kang, Dong-Ho;Lee, Chul-Hee;Hwang, Soo-Hyun;Park, In-Sung;Jung, Jin-Myung
    • Journal of Korean Neurosurgical Society
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    • v.50 no.4
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    • pp.341-347
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    • 2011
  • Objective : The purpose of this retrospective study was to evaluate the efficacy and safety of atlantoaxial stabilization using a new entry point for C2 pedicle screw fixation. Methods : Data were collected from 44 patients undergoing posterior C1 lateral mass screw and C2 screw fixation. The 20 cases were approached by the Harms entry point, 21 by the inferolateral point, and three by pars screw. The new inferolateral entry point of the C2 pedicle was located about 3-5 mm medial to the lateral border of the C2 lateral mass and 5-7 mm superior to the inferior border of the C2-3 facet joint. The screw was inserted at an angle $30^{\circ}$ to $45^{\circ}$ toward the midline in the transverse plane and $40^{\circ}$ to $50^{\circ}$ cephalad in the sagittal plane. Patients received followed-up with clinical examinations, radiographs and/or CT scans. Results : There were 28 males and 16 females. No neurological deterioration or vertebral artery injuries were observed. Five cases showed malpositioned screws (2.84%), with four of the screws showing cortical breaches of the transverse foramen. There were no clinical consequences for these five patients. One screw in the C1 lateral mass had a medial cortical breach. None of the screws were malpositioned in patients treated using the new entry point. There was a significant relationship between two group (p=0.036). Conclusion : Posterior C1-2 screw fixation can be performed safely using the new inferolateral entry point for C2 pedicle screw fixation for the treatment of high cervical lesions.

Airway Management Using the I-gel Supraglottic Airway Device in Patients with Grisel's Syndrome -Case Report- (그리셀증후군 환자에서 I-gel 성문상기도유지기를 사용한 기도관리 -증례보고-)

  • Lee, Cheolhyeong;Doo, A Ram;Woo, Cheol Jong;Son, Ji-Seon;Lee, Sang-Kyi;Kim, Yeon-dong
    • Journal of the Korea Convergence Society
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    • v.12 no.10
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    • pp.305-310
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    • 2021
  • Grisel's syndrome is a non-traumatic subluxation of the atlantoaxial joint with an inflammatory condition in the adjacent soft tissues. Due to the instability of the cervical spine, careful airway management is crucial to prevent potential cervical spinal cord injury following airway manipulation. We successfully secured the patient airway using a supraglottic airway device (I-gel) in a patient who had previously diagnosed with Grisel's syndrome. The operation was successfully completed, and the patient recovered without any neurological complications. I-gel can be a good option for airway management during general anesthesia in a patient diagnosed with Grisel's syndrome.

Unrecognized C1 Lateral Mass Fracture Without Instability: The Origin of Posterior Neck Pain

  • Seo, So-Jin;Kim, Hye-Rim;Choi, Eun-Joo;Nahm, Francis Sahn-Gun
    • The Korean Journal of Pain
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    • v.25 no.4
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    • pp.258-261
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    • 2012
  • Posterior neck pain is a common complaint of patients in the pain clinic. The atlas (C1) burst fracture is known to be a cause of posterior neck pain and instability. Although the atlas burst fracture and instability can be discovered by plain X-rays which show lateral mass displacement or widening of the atlantodental interval, assessment of an atlas burst fracture can be difficult if there is no instability in the imaging study. Here we report a case of a 46-year-old female patient who had complained of sustained posterior neck pain for 6 months. Plain X-rays showed only disc space narrowing at C4/5 and C5/6, without any cervical instability. However, an unrecognized C1 lateral mass fracture was detected by CT and MRI. The patient's pain was then successfully treated after atlantoaxial joint injection with a C2 DRG block.

Upper Cervical Subluxation and Cervicomedullary Junction Compression in Patients with Rheumatoid Arthritis

  • Chung, Jaewoo;Bak, Koang Hum;Yi, Hyeong-Joong;Chun, Hyoung Joon;Ryu, Je Il;Han, Myung-Hoon
    • Journal of Korean Neurosurgical Society
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    • v.62 no.6
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    • pp.661-670
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    • 2019
  • Objective : Rheumatoid arthritis (RA) is known to involve the cervical spine up to 86%. It often causes cervical instability like atlantoaxial subluxation (AAS), subaxial subluxation, and vertical subluxation (VS). In order to find the relation between RA and cord compression, we will evaluate the characteristics and risk factors of basilar invagination (BI) and cervicomedullary junction (CMJ) compression. Methods : From January 2007 to May 2015, 12667 patients administrated to Hanyang University Medical Center. Four thousand three hundred eighty-six patients took cervical X-ray and 250 patients took cervical computed tomography or magnetic resonance imaging. Radiologic parameters, medication records were obtained from 242 patients. Multivariate logistic regression analysis was performed with correlation of CMJ compression, basin-dental interval (BDI), basin-posterior axial line interval (BAI), pannus formation, BI, and AAS. Results : In the point of CMJ compression, atlantodental interval (ADI), posterior-atlantodental interval, BAI, AAS, and BI are relatively highly correlated. Patients with BI have 82 times strong possibility of radiologic confirmed CMJ compression, while AAS has 6-fold and pannus formation has the 3-fold possibility. Compared to the low incidence of BI, AAS and pannus formation have more proportion in CMJ compression. Furthermore, wrist joint erosion was correlated with VS and AAS. Conclusion : BI has a very strong possibility of CMJ compression, while AAS and pannus formation have a high proportion in CMJ compression. Hence bilateral wrist joint erosion can be used as an indicator for the timing of screening test for cervical involvement. We suggest the early recommendation of cervical spine examination for the diagnosis of cervical involvement in order to prevent morbidity and mortality.