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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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Andrievs J. Dzenitis

and an indwelling catheter drainage was maintained. Attempted pneumoencephalography failed to fill the ventricular system. Fig. 1. Lateral cervical spine film showing atlantoaxial subluxation. The atlanto-odontoid interval was 12–13 mm. Standard magnification, 72 inches target distance. Skeletal traction was applied to the skull by passing wire loops between 2 burr holes on either side of the midline in a sagittal direction. With 12 pounds traction, improvement in muscle strength in the extremities was noted, and reduction of the atlanto

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Alexander B. Rimalovski and Stanley M. Aronson

-rays were reexamined. A lateral x-ray of the skull, upper cervical vertebrae, and atlantooccipital junction which had been taken on the second day of the patient's first admission to the hospital now was found to show a retropharyngeal soft-tissue swelling which measured more than the usually accepted 70% of the antero-posterior diameter of a cervical vertebra ( Fig. 3 ). The lateral skull and cervical spine films taken 14 days later, upon reevaluation, showed that atlantoaxial subluxation was present, with separation of the odontoid process from the anterior arch of the

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

right and hypalgesia below T-4. The cranial nerves were normal. The neck was held rigidly. X-ray films of the cervical spine revealed subluxation of the odontoid process ( Fig. 1 ). The patient was treated with skeletal traction. Within ½ hour, neurological recovery began. Fig. 1. Midline sagittal tomogram (November 4, 1969) showing atlantoaxial subluxation by widening of the distance between the anterior ring of C-1 and odontoid (normal, 2 mm) up to 10 mm ( small closed arrow ); the film also shows the anterior offset of the spinous process of C-1 ( large

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methacrylate spinal fusion. Its use in spontaneous atlantoaxial subluxation in children. Egypt Orthop J 4 : 11 – 16 , 1969 Alsharif H: Methyl methacrylate spinal fusion. Its use in spontaneous atlantoaxial subluxation in children. Egypt Orthop J 4: 11–16, 1969

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Italo Rinaldi, William J. Mullins Jr., William F. Delaney, Peter M. Fitzer and David N. Tornberg

-axial joint following injury. With particular emphasis on rotational subluxation. Am J Roentgenol 76: 1081–1094, 1956 7. Watson Jones R : Spontaneous hyperaemic dislocation of the atlas. Proc R Soc Med 25 : 586 – 590 , 1932 Watson Jones R: Spontaneous hyperaemic dislocation of the atlas. Proc R Soc Med 25: 586–590, 1932 8. Wortzman G , Dewar FP : Rotary fixation of the atlanto-axial joint: rotational atlantoaxial subluxation. Radiology 90 : 479 – 487 , 1968 Wortzman G, Dewar FP: Rotary

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Craniocervical abnormalities

A comprehensive surgical approach

Arnold H. Menezes, John C. VanGilder, Carl J. Graf and Dennis E. McDonnell

. TABLE 1 Clinical summary of 17 patients treated for craniocervical junction abnormalities * Case No. Age (yrs), Sex Clinical Presentation Radiological Findings Treatment Results 1 12, F juvenile rheumatoid arthritis age 6 yrs; slurred speech; spastic quadriparesis; neurogenic bladder for 3 yrs polyarticular rheumatoid involvement; severe atlantoaxial subluxation; CM compression, reducible in extension halo cast in extension; posterior fusion C1–2 recovered 2 7, M occipital headaches; neck stiffness 1 yr

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Narayan Sundaresan, Joseph H. Galicich, Joseph M. Lane and Harry S. Greenberg

interval between the diagnosis of cancer and diagnosis of odontoid fracture varied considerably (0 to 14 years), with a median of 3 years. Radiological Features The diagnosis of odontoid fracture with atlantoaxial subluxation was easily established by plain lateral radiographs in 17 patients ( Fig. 1 ). In one patient, plain x-ray films were unrevealing, and the diagnosis was made following tomography ( Fig. 2 ). In three patients, initial cervical spine x-ray films were obtained because of neck pain and were thought to be normal. Neck pain persisted, and

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John T. Lucas, Gordon D. Hungerford and Phanor L. Perot Jr.

the axis; and pelvic traction directed caudally. Fig. 3. Lateral cervical radiograph after removal of the Minerva jacket. Flexion and extension radiographs, not demonstrated, revealed no movement of the atlas in respect to the axis. Discussion The first case of atlantoaxial subluxation due to an inflammatory process was reported in 1830 by Sir Charles Bell. 1 In that case, autopsy revealed erosion of the transverse ligament of the atlas by an inflammatory process which had spread from a pharyngeal ulcer. Atlantoaxial subluxation associated

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Timothy Mapstone and Robert F. Spetzler

cervical spondylosis. J Neurosurg 23: 596–602, 1965 2. Jones MW , Kaufmann JCE : Vertebrobasilar artery insufficiency in rheumatoid atlantoaxial subluxation. J Neurol Neurosurg Psychiatry 39 : 122 – 128 , 1976 Jones MW, Kaufmann JCE: Vertebrobasilar artery insufficiency in rheumatoid atlantoaxial subluxation. J Neurol Neurosurg Psychiatry 39: 122–128, 1976 3. Nagashima C : Surgical treatment of vertebral artery insufficiency caused by cervical spondylosis. J Neurosurg 32 : 512 – 521 , 1970