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Non-Traumatic Atlanto-Axial Dislocation

Report of Case with Recovery after Quadriplegia

Leonard A. Titrud, C. A. McKinlay, Walter E. Camp and Hewitt B. Hannah

. M. Clinical observations on the surgical pathology of bone. Edinburgh : Oliver & Boyd , 1931 , xi, 248 pp. (see pp. 227, 228) . Greig , D. M. Clinical observations on the surgical pathology of bone. Edinburgh: Oliver & Boyd , 1931, xi, 248 pp. (see pp. 227, 228). 9. Hess , J. H. , Abelson , S. M. , and Bronstein , I. P. Spontaneous atlantoaxial dislocations. Possible relation to deformity of spine. Amer. J. Dis. Child. , 1942 , 64 : 51 – 54 . Hess , J. H., Abelson , S. M., and Bronstein , I. P

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Vertebral Artery Insufficiency in Acute and Chronic Spinal Trauma

With Special Reference to the Syndrome of Acute Central Cervical Spinal Cord Injury

Richard C. Schneider and George W. Schemm

arteries might be compressed simultaneously at three main sites: a) Any fracture-dislocation of the cervical spine above the C6 intervertebral foramen may cause compression of the vessels at the displaced intervertebral foramina. b) Atlantoaxial dislocation will cause compression at the C1 intervertebral foramina. c) Atlantoaxial dislocation may cause compression at the point where the occipital condyle slides forward over the well indented groove in the lamina of the first cervical vertebra. With bilateral spasm or compression of the vertebral artery, a relative

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Spontaneous Dislocation of the Atlas

Report of a Case Simulating Syringomyelia with a Discussion of Etiology and Methods of Treatment

Paul Skok, John Kapp and Charles E. Troland

-traumatic anomalies of the atlas and axis. J. Bone Jt. Surg. , 1957, 39-A: 1289–1301. 12. Lourie , H. , and Stewart , W. A. Spontaneous atlantoaxial dislocation. A complication of rheumatoid disease. New Engl. J. Med. , 1961 , 265 : 677 – 681 . Lourie , H., and Stewart , W. A. Spontaneous atlantoaxial dislocation. A complication of rheumatoid disease. New Engl. J. Med. , 1961, 265: 677–681. 13. Mabon , R. F. , and Lovell , W. W. Spontaneous atlantoaxial subluxation accompanied by

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George C. Stevenson, Ronald J. Stoney, Roland K. Perkins and John E. Adams

. Dunbar , H. S. , and Ray , B. S. Chronic atlantoaxial dislocations with late neurologic manifestations. Surg. Gynec. Obstet. , 1961 , 113 : 757 – 762 . Dunbar , H. S., and Ray , B. S. Chronic atlantoaxial dislocations with late neurologic manifestations. Surg. Gynec. Obstet. , 1961, 113: 757–762. 21. Fang , H. S. Y. , and Ong , G. B. Direct anterior approach to the upper cervical spine. J. Bone Jt. Surg. , 1962 , 44-A : 1588 – 1604 . Fang , H. S. Y., and Ong , G. B. Direct anterior approach to the

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David G. Kline

of atlanto-axial dislocation secondary to os odontoideum . His patient had transitory disturbances of vision, vertigo, and syncope associated with excessive mobility of the atlas and presumed vertebral insufficiency. The possible role of vertebral insufficiency with trauma to the other cervical vertebrae has been emphasized elsewhere. 11 Fracture of the odontoid, 1 rupture or dissolution of the transverse ligament, 2 and hypoplasia or agenesis of the odontoid can result in atlantoaxial dislocation. The odontoid is ossified from 3 centers. 5 Two lateral

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Andrievs J. Dzenitis

atlantoaxial dislocation. 2, 4, 7, 21, 25–27 Signs of spinal cord compression are unusual, 5 and particularly rare in children. 13 Martel 15 found no neurologic manifestations in 70 mongoloids studied, 14 of whom had atlas dislocations. 15 In the present case, the dislocation may have occurred as a sequel to the ear infection, or may have been previously asymptomatic, and become clinically manifest concommitantly with, but not due to, the illness. As no previous cervical spine films were available, either explanation appears equally plausible. The ultimate diagnosis

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Alvin D. Greenberg, William B. Scoville and Lycurgus M. Davey

. The two cases we are reporting stimulated us to review the pathophysiology of atlantoaxial dislocations due to hypoplasia or “dysgenesis” of the odontoid process and to attempt what we feel is a rational, relatively safe, surgical procedure for the treatment of this disorder. Surgical Procedure Preoperative preparation A tracheostomy should be performed 1 to 3 days prior to surgery. Nose and throat cultures should be obtained and the patient placed on appropriate antibiotic therapy; teeth should be examined for signs of occult infection. Operative

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Abbott J. Krieger, Hubert L. Rosomoff, Abraham S. Kuperman and Lawrence H. Zingesser

Discussion The potentially serious changes in pulmonary function associated with craniovertebral anomalies are worth noting. A recent report of respiratory dysfunction in an attempt to relieve compression in the cervicomedullary region resulting from atlantoaxial dislocation emphasizes this problem. The patient had had respiratory insufficiency before surgery and was made worse by attempted reduction with skeletal traction. A transoral resection of the dens resulted in improvement, but intermittent respiratory assistance was still necessary 11 months after surgery. 5

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Chikao Nagashima

. , Barraquerferré , L. , Canadell , J. M. , and Modolell , A. Delayed myelopathy following atlantoaxial dislocation by separated odontoid process. Brain , 1955 , 78 : 537 – 553 . Bachs , A., Barraquer-bordas , L., Barraquerferré , L., Canadell , J. M., and Modolell , A. Delayed myelopathy following atlantoaxial dislocation by separated odontoid process. Brain , 1955, 78: 537–553. 3. Cone , W. , and Turner , W. G. The treatment of fracture-dislocation of the cervical vertebrae by skeletal traction and fusion. J

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Michael H. Sukoff, Milton M. Kadin and Terrance Moran

of “spontaneous.” The latter includes acute inflammatory conditions, 4, 5 complications of steroid therapy, 15 and Mongolism. 7 Odontoid agenesis and the os odontoideum are developmental anamolies that predispose the individual to dislocation from minor neck injuries. 21, 22 Non-traumatic occipital-atlantoaxial dislocation is a well-known and grave complication of rheumatoid arthritis. 15, 19, 28 The rheumatoid process can involve the bursae found on either side of the odontoid process, the joints of Luschka, the dens itself, and both the tectorial membrane