Atlanto-occipital Subluxation Research Articles

Analysis of features of frontal collision of class D cars

Currently, there is a significant increase in road accidents, which can be associated with an increase in the number of cars, the condition of roads in the country and compliance with road discipline by road users. Modern automotive industry pays great attention to road safety. This is ensured by changes in the design of car interiors, which significantly affects the nature of injuries to victims of road accidents. That is why the solution of this issue has become extremely relevant for forensic expert practice.
 Aim of the work. To establish the characteristic injuries of the driver and passenger in the cabin of class D cars in a frontal collision.
 Material and methods. The analysis of road accidents from 2008 to 2021 in Zhytomyr, Rivne, Volyn regions of Ukraine is carried out. Cases of a fatal head-on collision with a driver and passenger in the front seat of a car with an engine capacity of 2-2.5 liters up to 4.7 meters long and 1.81 meters wide were considered. General and special methods used: system-structural analysis, observation, comparison, description. In addition, a forensic examination of the damage was conducted. Statistical analysis included primary data processing by descriptive statistics methods and null hypothesis testing by multifactor analysis.
 Results. A number of new features have been identified, which are inherent in the damage received in the cabin of a class D car, which can help to identify during the forensic examination. In particular, you should pay attention to the presence of neck injuries. According to the literature, injuries of the cervical spine are among the key and include: rupture of the atlanto-occipital ligament, dislocation and subluxation of the atlanto-axial joint, damage to the spinal cord and its membranes.
 Conclusions: The location and morphological features of spinal injuries can be used as diagnostic criteria in determining the location of the victim in the cabin of a mobile car class D in a frontal collision. The most informative is the analysis of injuries of the cervical spine of the driver and front passenger.

Life-threatening retropharyngeal fluid collection after whiplash-type injury of the cervical spine

A 39-year-old man was brought to the emergency department after a car accident. Computed tomography scans of the brain and spine did not reveal any fracture of the craniocervical junction except some thickening of the retropharyngealprevertebral soft tissues, mild increase of the basion-dens interval with basion-axis interval (Fig. 1), and atlantooccipital subluxation (Fig. 2). Also we observed thin linear hyperdensities compatible with subdural hemorrhagia extending through anterior neighborhood of the brainstem and posterior neighborhood of the proximal cervical spinal cord (Fig. 3). The patient developed progressive dyspnea and hoarseness while being monitored in intensive care unit and a magnetic resonance imaging (MRI) scan of the cervical spine was obtained. A retropharyngeal fluid collection extending through the naso-oro-hypopharynx levels was found which also extended into the deep fascial planes of the neck.

Retrospective review of 22 surgically treated adults with congenital anomalies of the upper cervical spine: a clinical and radiological review.

The purpose of this study was to clarify the characteristics of adult cases with instability due to upper cervical spine anomalies who needed fusion surgery regarding the clinical and radiological findings. Twenty-two consecutive patients with instability due to upper cervical spine anomaly in adult cases were reviewed. The congenital anomalies included idiopathic atlanto-axial subluxation in nine cases, os odontoideum in seven cases, occipitalization of the atlas in four cases, atlanto-occipital subluxation in one case and AAS with another anomaly in one case. We evaluated the severity of neurological symptoms before surgery and at the last follow-up. We also observed MR images before and 1year after surgery. Before surgery, the 22 patients included seven Ranawat Grade I cases, ten Ranawat Grade II cases, and five Ranawat Grade IIIa cases. Regarding the neurological status after surgery, those included eighteen Ranawat Grade I cases, three Ranawat Grade II cases, and one Ranawat Grade IIIa case. Preoperative T2-weighted MR images demonstrated intramedullary high signal intensity (IHSI) in 12 cases. IHSI group did not include significantly more Ranawat Grade IIIa cases compared to the remaining 10 cases. In postoperative MR images (nine cases), the regression or disappearance of IHSI was demonstrated in only three cases. In adult cases with instability due to upper cervical spine anomalies, we acquired favorable clinical outcomes after surgery. Regarding the neurological severity before surgery, there was no relationship with the IHSI on T2-weighted MR image. Moreover, the regression or disappearance of IHSI after surgery was not frequently demonstrated.

Traumatic atlanto-occipital dissociation presenting as locked-in syndrome

We present an unusual presentation of unstable atlanto-occipital dissociation as locked-in syndrome. Traumatic atlanto-occipital dissociation is a severe injury that accounts for 15–20% of all fatal cervical spinal injuries. A disruption occurs between the tectorial ligaments connecting the occipital condyle to the superior articulating facets of the atlas, resulting in anterior, longitudinal, or posterior translation, and it may be associated with Type III odontoid fractures. Furthermore, the dissociation may be complete (atlanto-occipital dislocation) or incomplete (atlanto-occipital subluxation), with neurologic findings ranging from normal to complete quadriplegia with respiratory compromise.

Surgical Treatment for Atlanto-Occipital Subluxation due to Destructive Spondyloarthropathy in a Patient Undergoing Long-Term Hemodialysis.

Destructive spondyloarthropathy (DSA) has been reported in patients undergoing long-term hemodialysis. Cervical spinal lesions, including those of the upper cervical spine, are reported to be some of the most common. To our knowledge, we report for the first time, a case of atlanto-occipital subluxation requiring surgical treatment due to severe myelopathy and nuchal pain in a patient undergoing long-term hemodialysis. The patient was a 66-year-old woman who had undergone hemodialysis for 40 years. She visited our hospital due to an acute progression of gait disturbance and severe nuchal pain. Computed tomography showed posterior subluxation of the atlanto-occipital joints. DSA was also observed in the lower cervical spine. Magnetic resonance imaging showed spinal canal stenosis at both the upper and lower cervical levels. We performed Oc-C7 fixation, C1 laminectomy, and C3-C7 laminoplasty. We first recognized that the atlanto-occipital subluxation was caused by the extremely long-term, in this case, 40 years, hemodialysis.

Traumatische atlanto-occipitale subluxatie en craniale cervicale blokwervels bij een steenarend (Aquila chrysaetos)

Een steenarend (Aquila chrysaetos) werd onderzocht voor evenwichtsproblemen die ontstaan waren na trauma door een harde landing tijdens de fi tnesstraining. Met magnetische resonantie en computertomografi e werd een chronische atlanto-occipitale subluxatie aangetoond met een craniodorsale verplaatsing van de atlas (atlanto-occipitale overlapping) en secundair een dynamische compressie van de hersenstam en het ruggenmerg. Bovendien werd een malunion van een oudere fractuur gezien met fusie van C1 en C2. De vogel werd geëuthanaseerd omwille van de klinische achteruitgang en een slechte prognose.

Acquired Torticollis Related to Atlantooccipital Subluxation Following Servical Burn

Acquired Torticollis Related to Atlantooccipital Subluxation Following Servical Burn

Subclinical Chronic Atlanto-Occipital Rotatory Fixation: A Case Report.

Cases of symptomatic atlanto-occipital rotatory subluxation and dislocation caused by trauma, tumor, inflammatory disease, or congenital anomaly have been previously reported1-3. These conditions can be highly unstable and result from osteoligamentous disruption between the occipital bone (Oc) and the axis (C2)4,5. To the best of our knowledge, there have been no reports of cases of asymptomatic chronic atlanto-occipital rotatory fixation (AORF). While there are patients who may be asymptomatic neurologically and only present with neck pain, we report an extremely rare case of subclinical chronic AORF with previous symptomatic atlantoaxial rotatory fixation (AARF). The patient and her parents were informed that data concerning the case would be submitted for publication, and they provided consent. A previously healthy eleven-year-old girl presented to our clinic with a two- month history of neck pain and torticollis without any traumatic history or prodromal symptoms (e.g., fever). She had torticollis with a tilt of the head to the right (Fig. 1-a). Physical examination revealed restricted neck motion; lateral cervical spine bending was limited to 30° to the right and 0° to the left, and rotation was limited to 30° to the right and 40° to the left. She had no excessive ligamentous laxity. Neurologic examination revealed no abnormalities. Computed tomography (CT) showed 12° rotation to the left of C1 on C2, and 32° rotation to the right of the occipital bone on the atlas (C1) (Fig. 2-a). The diagnosis of concomitant AARF and AORF was made after CT scanning. Lateral dynamic radiographs of the cervical spine showed neither atlantoaxial nor atlanto-occipital instability (Figs. 3-a, 3-b, and 3-c). Fig. 1 At presentation, the patient exhibited torticollis ( Fig. 1-a) . After a sequence of conservative treatments, she showed no cervical abnormality ( Fig. 1-b ). Fig. 2 CT axial images of the occipitoatlantoaxial …

Radiological investigation of an over 2000-year-old Egyptian mummy of a cat.

A radiographical study of a cat mummy from the Egyptian collection of the National Archeological Museum in Parma, Italy was carried out in order to evaluate the content and to describe how cats were wrapped and mummified. The mummy contained the complete skeleton of a 4-5-month-old cat. Radiology revealed the position of the cat's body; it was wrapped to occupy the smallest space possible. In order to better position the cat, the ribs of the thorax were compressed cranio-caudally and the fore limbs were then positioned very close to the thorax. The hind limbs were flexed close to the lumbar spine and the tibio-tarsal joints were subluxated to allow the repositioning of the tarsal, metatarsal and phalanx bones cranio-caudally near the tibiae. A coccygeal vertebra was fractured in order to reposition the tail as close as possible to the body. Atlanto-occipital subluxation and a fracture/hole was present in the occipital region of the skull: whether this was made for draining skull contents as a mummification process and/or to euthanase the cat remains open for discussion.

Traumatic Retropharyngeal Pseudomeningocele with Atlanto-Occipital Dislocation in a Neurologically Intact Patient

Traumatic retropharyngeal pseudomeningoceles occur rarely, are associated with severe trauma, and have been reported in patients with significant neurologic deficits at presentation. We report the rare occurrence of a pseudomeningocele following a high-speed motor vehicle accident. Neurological examination showed the patient to be briskly following commands, with intact cranial nerve, motor, and sensory function. CT/MR imaging showed subarachnoid hemorrhage involving the interpeduncular cistern, a clivus fracture, a right occipital condyle fracture, an atlanto-occipital subluxation, aortic arch transection (stable and contained on CT angiogram), multiple rib fractures on the right side with associated pneumothorax, hemothorax and pulmonary contusions. His cervical spine was stabilized in a halo. He was subsequently managed in the intensive care unit and remained neurologically intact. A repeat MRI showed the interval development of a 2×1.5 cm pseudomeningocele at the craniocervical junction medial to the left occipital condyle communicating with the left anterolateral aspect of the spinal canal. Traumatic pseudomeningoceles are associated with large deceleration forces at the time of injury and are usually associated with significant neurologic deficits at presentation. However, they can arise and give rise to symptoms in a delayed fashion in trauma patients who are neurologically intact at initial presentation.

Diagnosis and Treatment of a Chronic Atlanto-Occipital Subluxation in a Dog

A 6-year-old Labrador retriever-cross was evaluated for an abnormal gait and head carriage 6 weeks after suffering trauma. The dog was presented with an ambulatory tetraparesis and was reluctant to move his head. Myelography and computed tomography demonstrated a subluxation of the atlanto-occipital joint with compression of the spinomedullary junction and the brain stem by the occipital bone. Removal of the compressive part of the occipital bone resulted in improvement of the clinical signs within 6 weeks, and resolution of clinical signs occurred 8 months after surgery.

Cervical Spine Considerations When Anesthetizing Patients with Down Syndrome

It is characterized by mental retardation, as well as craniofacial, upper airway, cardiovascular, and gastrointestinal anomalies. One manifestation of DS relevant to anesthesiologists is upper cervical spine instability produced by ligamentous laxity, skeletal anomalies, or both. This instability can result in neurologic impairment, including quadriplegia. However, there are no evidencebased practical guidelines to aid anesthesiologists in caring for these patients. The risk of spinal cord injury during anesthesia is unknown, as are the preoperative factors that might aid in accurately defining the risk in specific patients. Review of Normal Upper Cervical Spine Anatomy The structures relevant to this discussion include the base of the skull, the atlas (C1), and the axis (C2). The articulations between these structures are complex but are designed to facilitate maximal movement without compressing the spinal cord. The motions are flexion extension and rotation; little lateral bending occurs in this area.

Atlanto‐axial rotatory fixation: Improved demonstration using spiral CT

Atlanto-axial rotatory fixation (AARF) is an uncommon condition which is often missed at presentation because of its rarity and the relative subtlety of plain film X-ray findings, but early detection and appropriate management are vital for a cure. We describe three cases in which the use of spiral computed tomography scanning with 3D and sagittal reconstructions greatly aided diagnosis and management. The 3D images gave a more graphic picture of the overall alignment of the upper cervical spine and the skull base, while the sagittal reconstructions demonstrated the presence or absence of compensatory atlanto-occipital subluxation. The literature is briefly reviewed.

Posterior Decompression and Fusion in Rheumatoid Disease of the Cervical Spine

Forty-seven patients with rheumatoid disease of the cervical spine were followed over an 8-year period. Twenty-one patients with isolated atlantoaxial subluxation and four with combined atlantoaxial and subaxial disease had their atlantoaxial instability treated by posterior decompression and fusion. The incidence of surgical mortality was 8%, and clinical improvement was noted in 75%. There was no neurological deterioration in those patients who survived long term. We have found posterior decompression and fusion to be a satisfactory procedure for the treatment of atlantooccipital subluxation. In our experience, anterior decompression has not been found necessary for successful treatment of atlantoaxial subluxation in patients with rheumatoid cervical spine disease.

Atlantooccipital Subluxation in a Neonate with Down’s Syndrome

Atlantooccipital subluxation (AOS) occurs in up to 63% of patients with Down's syndrome. However, presenting symptoms and the age at which preoperative screening becomes necessary have not been clearly delineated. Recently, a 16-day-old female with Down's syndrome and AOS presented to our institution. Following patent ductus arteriosus ligation, her neurological examination revealed trace movement, few spontaneous respirations, and left lower extremity clonus. Cervical spine radiographs revealed significant AOS. She was reduced and underwent a fusion from the occiput to C2. She gradually regained full strength and sensation. This case is the youngest example of AOS related to Down's syndrome described. It emphasizes the need for preoperative screening of all patients with Down's syndrome.

Atlanto-occipital subluxation in Down syndrome

Atlanto-occipital subluxation (AOS) in individuals with Down syndrome is discussed using five new cases and nine patients previously presented in the literature. Although AOS is likely due to ligamentous laxity, it was associated with atlantoaxial instability in only two youngsters. Reducible C1-C2 rotary subluxation was present in a third. Posterior movement of the occiput with respect to C1 occurred on extension and reduced on flexion in all but one individual who demonstrated anterior subluxation. Neurological problems are described in only two individuals: one with severe atlantoaxial subluxation (AAS) and the other with multiple cervical spine anomalies. Since AOS is usually detected on films obtained to screen children with Down syndrome for AAS, the atlanto-occipital joint should be carefully studied on these radiographs. The clinical significance of AOS needs to be determined.

Bulbar symptoms and episodic aphonia associated with atlanto-occipital subluxation in ankylosing spondylitis.

A patient with intermittent aphonia associated with atlanto-occipital subluxation due to ankylosing spondylitis is presented and discussed. The only other case from the literature is reviewed and compared with our patient, where symptoms and signs of episodic low bulbar disease, presumably due to intermittent vascular insufficiency, were relieved by external bracing.