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By Dr.Ravindra Patil<\/p>\n
This condition occurs in the neck when the first two cervical vertebrae move away from their positions. Luckily this is a very rare condition. But if ever it occurs, it may have serious implications. The patient may suffer quadriplegia, that is, paralysis<\/a> of all the body below the neck. But before we understand what is atlantoaxial dislocation, we must understand the anatomy of the cervical spine, and especially the first vertebra of the spinal column, called the \u2018atlas\u2019, and the second vertebra, which is called the \u2018axis\u2019. The two vertebrae, the atlas and axis, are joined at what is called the atlantoaxial joint.<\/p>\n The cervical spine is the upper portion of the vertebral column, lying between the skull and the thoracic or chest vertebrae. It has seven vertebrae, two of which are given unique names:<\/p>\n The cervical vertebrae, seven in all, are different from the other vertebrae and are a bit more delicate. We will focus on the first two cervical vertebrae.<\/p>\n The atlas is the first cervical vertebra and lies between the skull and the axis vertebra. It differs from the other cervical vertebrae considerably.<\/p>\n The axis lies between the atlas and the third cervical vertebra. It articulates with the atlas through the medial atlanto-axial joint. This joint allows for rotation of the head independently of the torso.<\/p>\n The axis also articulates with the atlas to form the two lateral atlanto-axial joints.<\/p>\n There are six major ligaments in the cervical spine. The ligaments are strong tensile connective tissue which hold the vertebrae together.<\/p>\n \t\tInjury due to vertical fall<\/strong> For RAAD, Posterior fusion is done. Screws are fixed across joints and vertebral bodies and wiring is done. Often, IAAD is due to inadequate extension in dynamic X-ray study which may also be due to spasm of muscles.<\/p>\n The above is a very simplistic explanation of a very complex surgical process. Various different methods are there to treat AAD [atlanto-axial dislocation]. However, it will be too complicated for non-medical people to understand, hence it is not described in detail.<\/p>\n The surgeries require high precision. That is why hospitals like Samarth Neuro and Multispeciality Hospital located in Miraj are able to conduct such complex surgeries. Because Samarth Hospital has surgical navigation system which is the only way to manage such complex injuries.<\/a><\/p>\n While it may seem to the reader that the complexity of atlanto axial subluxation or dislocation is being exaggerated, it should be remembered that if the surgery goes wrong even slightly, the patient may suffer quadriplegia or even death. There is only one chance for the perfect surgery. Otherwise the patient may suffer with failed surgery.<\/p>\n Hence the use of surgical navigation, which pinpoints the exact locations where the initial incisions are to be taken and the exact spots where screws and wires are to be fitted so as to prevent injury to the spinal cord<\/a> and the spinal nerves coming out between vertebrae.<\/p>\n There are no are medicines for atlantoaxial instability (AAI), subluxation or dislocation. Because of the chronicity of the instability at the time of presentation in most cases, corticosteroids have little, if any benefit. Neurologic problems do not get better with corticosteroids. In fact they may cause side effects. In the acute traumatic setting, corticosteroids remain controversial. Guidelines provided by the American Academy of Neurological Surgeons (AANS) include level I evidence against the use of corticosteroids or gangliosides in the acute trauma patient.<\/p>\n\n\t\t\t\tTable of Contents\t\t\t<\/h4>\n
Anatomy of the Cervical Spine <\/h2>\n
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Atlas vertebra <\/h3>\n
Axis vertebra<\/h3>\n
Ligaments of the cervical spine<\/h3>\n
Injuries of the cervical spine<\/h3>\n
\nA vertical fall onto an extended neck e.g. diving into excessively shallow water can compress the lateral masses of the atlas between the occipital condyles and the axis. This causes them to be driven apart, fracturing one or both anterior\/posterior arches.
\nIf the fall occurs with enough force, the transverse ligament of the atlas may also be ruptured.
\nHyperextension (Whiplash) Injury
\nA rear-end traffic collision or a poorly performed rugby football tackle can both result in the head being whipped back on the shoulders, causing whiplash. In minor cases, the anterior longitudinal ligament of the spine is damaged which is acutely painful for the patient.
\nAtlantoaxial Subluxation<\/strong>
\nThe worst-case scenario for these injuries is that dislocation or subluxation of the atlas and axis occurs. Subluxation means a slight misalignment of two vertebrae in relation to each other. It is the cause of many health problems. This often happens at the axis vertebra level, where its body of moves forward with respect to the third cervical vertebra. Such an injury may well lead to spinal cord damage. Quadriplegia or death may occur. More commonly, subluxation occurs at the lower levels of the cervical spine.
\nHangman\u2019s Fracture<\/strong>
\nHangman\u2019s fracture refers to a fracture of the bony column of the axis vertebra. It typically occurs as a result of high velocity hyperextension and distraction of the head. Such an injury is likely to be lethal as rupture the spinal cord may occur, causing deep unconsciousness, respiratory failure and cardiac failure.
\nFracture of the Dens<\/strong>
\nOccurs in the axis vertebra. These fractures are often unstable and are at high risk of avascular necrosis.<\/a> As with any fracture of the vertebral column, there is a risk of spinal cord involvement.
\nDislocation of the Atlanto-Axial Joint<\/strong>
\nAtlanto-axial Dislocation or Fracture can cause severe spinal cord compression resulting in significant neurological injuries of upper spinal cord and lower medulla oblongata. Patient may suffer paralysis of all four extremities (quadriplegia). Severe neck pain is spread over back of the neck and arms. Patient will also have continuous chronic pain.
\nAtlanto-axial dislocations (AADs) may be classified into four varieties depending upon the direction and plane of the dislocation i.e. anterior-posterior, rotatory, central, and mixed dislocations. However, from the surgical point of view these are divided into two categories i.e. reducible [RAADs or Reducible Atlanto Axial Dislocations] and irreducible [IAADs or Irreducible Atlanto Axial Dislocations].\t\t<\/p>\nSurgical Treatment <\/h3>\n
Medical Care<\/h3>\n