Atlantoaxial Level Research Articles

Computed tomographic myelography (CTM) in atlanto-axial rheumatoid arthritis

Thirty-two patients with severe cervical rheumatoid arthritis were investigated preoperatively with cervical myelography (CeM) and computed tomographic myelography (CTM). The severity of their clinical symptoms correlated excellently with a combination of the deformation of the spinal cord at the atlanto-axial level, the lateral dislocation of the cord at the same level, and the deformation of the cord at some lower cervical level. Obstructing soft-tissue excrescences seemed to have little significance. No correlation was found in this study between the deformation of the cord and the main findings of the plain films: the atlanto-axial subluxation (AAS), the vertical subluxation (VS), or their combination.

Fusion of the Cervical Spine for Instability

The orthopedic and neurosurgical literature is neither clear nor consistent in describing an unstable cervical spine. In a series of 25 patients treated by arthrodesis of the cervical spine for instability, 12 had Gallie fusions at the atlantoaxial level. Eight of those fusions were performed for rheumatoid arthritis. In three patients persistent subluxation of the atlas on the axis occurred because the wires were not fully tightened in areas of poor-quality bone. Stable fixation with relief of symptoms was achieved in all patients who had fusions at the subaxial level. Several of these patients had had prolonged nonsurgical treatment. With rheumatoid bone of poor quality, the surgeon must be very careful to tighten the wires only enough to secure a stable reduction for treatment of subaxial cervical instability. Since stability achieved by healing of soft tissue is generally unreliable, prolonged periods of nonsurgical treatment are not justified for traumatic instability.

Vertebrobasilar arterial occlusions in children

Three children with angiographically confirmed, sudden thrombosis involving the vertebro basilar arterial system are presented. Ten previously reported cases are reviewed with particular regard to possible etiologies. Vertebral artery trauma at the atlantoaxial level is suspected as one important cause.

On Various Subluxations of the Cervical Spine of Patients with Rheumatoid Arthritis

Pain and stiffness of the neck are not uncommonly seen in the patient with rheumatoid arthritis. The x-ray of those patients shows various degree of subluxations of the cervical spine.In our cases the subluxation is most often situated at the atlanto-axial level, but is also less often observed below the second cervical level. One patient reveals the vertical subluxation of odontoid and other shows the posterior displacement of the third cervical spine. Those two patients developed the tetraparesis due to the probable damage of the spinal cord.The degree of the cervical subluxation are closely related to the duration of disease, rheumatoid involvement of the peripheral joint, and the adequacy of the glucocorticoid therapy.