Atlanto-Axial Subluxation With Cervical Myelopathy Operated With Occipital C2 Fusion: A Case Report

Rahul Kadam, Vishal Bauva, Krutarth Shah, Sunil Yadav
2017 Zenodo  
Atlanto-axial subluxation with cervical myelopathy is a rare condition that can occur mainly by trauma followed by Rheumatoid arthritis, Grisel syndrome, Down's syndrome and various other metabolic disorders. It is characterized by excessive movement of atlas (C1) over axis (C2) either by bony or ligamentous abnormality. Due to its laxity the spinal cord may get damaged and cause neurologic symptoms. Reduction and fixation is needed for such instability. KEYWORDS: C1-C2 subluxation, Cervical
more » ... xation, Cervical myelopathy, Occipital C2 fusion. INTRODUCTION Atlantoaxial subluxation (AASL) is rare and mostly follows trauma but in our case the etiology was a degenerative cause to the cranio-vertebral junction (CVJ) [1]. Biomechanics include a repeated force of translation of C1 over C2 which leads to cord edema which gradually leads to cervical myelopathy. Most of the patients are neurologically intact [1,2]. Closed reduction and collar immobilization has been reported to be successful in a few cases though intact transverse axial ligament (TAL) is a prerequisite for conservative management [1,3]. Most of the previously reported cases have been managed with C1-C2 fusion [1]. We describe a patient with isolated ligamentous injury, without any fractures at CVJ and with neuro deficit managed with occipital cervical fusion. It is a rare case as most of the subluxation are a cause of trauma, Grisel syndrome or RA but this is a case of chronic degeneration of the transverse ligament leading to subluxation eventually leading to myelopathy of cervical spine. TYPES OF SUBLUXATION Table 1. Fielding Classification of AASL [4] Type I: Unilateral facet subluxation with intact transverse ligament. Odontoid acts as a pivot point and there is no anterior subluxation. Most common and benign type. Type II: Unilateral facet subluxation with 3 to 5 mm of anterior displacement. Injured Transverse ligament One facet acts as pivot point and one later [...]
doi:10.5281/zenodo.321969 fatcat:zkg27tzxjzaixo4vvxc4q7lwxi