Abstract
Objective. To analyze clinical and radiological features of congenital atlantoaxial dislocations (AAD) in congenital craniovertebral junction malformations. Material and Methods. The data of 26 patients with AAD associated with congenital pathology of the craniovertebral junction, who applied to the Ilizarov Center in 2012–2017, were analyzed. Results. Patients were divided into three groups: with nonsyndromic AAD – 6 (23.1 %) patients, with AAD associated with Klippel – Feil syndrome – 11 (42.3 %) and with syndromic AAD – 9 (34.6 %). Odontoid anomalies were observed in 15 (57.7 %) patients, the magnitude of dislocation was determined from the C 1 facet displacement relative to that of C 2 in different planes. Patients with non-syndromic AAD had local pain syndrome (VAS score 4.20 ± 2.64) accompanied by torticollis and restriction of head movements, and myelopathy. In patients with AAD associated with Klippel – Feil syndrome, the local symptoms prevailed: restriction of neck movements, torticollis, neck pain (VAS score 2.40 ± 2.01), and myelopathy. Myelopathy and unpronounced pain syndrome (VAS score 2.30 ± 1.94) were leading symptoms in patients with syndromic AAD. Conclusion. Patients with syndromic AAD more often have myelopathy, whereas AAD with the Klippel-Feil syndrome and non-syndromic AAD are often manifested by local symptoms.
Highlights
Clinical and radiological features of atlantoaxial dislocations associated with congenital malformations of the craniovertebral junction O.M
In patients with atlantoaxial dislocations (AAD) associated with Klippel – Feil syndrome, the local symptoms prevailed: restriction of neck movements, torticollis, neck pain (VAS score 2.40 ± 2.01), and myelopathy
При измерении углов наклона фасеток С1 в сагиттальной плоскости отмечены следующие закономерности: 1) угол наклона острее в группе несиндромальных атлантоаксиальных дислокаций (ААД) и ААД на фоне синдрома Клиппеля – Фейля; 2) самое пологое расположение плоскости нижних фасеток С1 и наименьший разброс показателей – в группе синдромальных ААД, то есть они были наиболее нестабильными и подвижными, что подтверждает наличие у всех пациентов данной группы аномалий развития зубовидного отростка; 3) средняя величина наклона фасеток – 136,40° ± 48,61° справа и 136,90° ± 44,6° слева во всех группах, то есть менее 150°, что объясняет бóльшую частоту возникновения дислокации С1 в сагиттальной плоскости
Summary
To analyze clinical and radiological features of congenital atlantoaxial dislocations (AAD) in congenital craniovertebral junction malformations. In patients with AAD associated with Klippel – Feil syndrome, the local symptoms prevailed: restriction of neck movements, torticollis, neck pain (VAS score 2.40 ± 2.01), and myelopathy. Клинико-радиологические особенности атлантоаксиальных дислокаций на фоне врожденных аномалий развития краниовертебрального перехода // Хирургия позвоночника. Clinical and radiological features of atlantoaxial dislocations associated with congenital malformations of the craniovertebral junction. Атлантоаксиальные дислокации на фоне аномалий развития краниовертебрального перехода O.M. Pavlova et al Atlantoaxial dislocations associated with congenital malformations of the craniovertebral junction. Атлантоаксиальные дислокации (ААД) на фоне врожденных аномалий краниовертебрального перехода наиболее широко изучены в Индии и Китае [17, 27, 36,37,38].
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