A Morphologically Atypical Case of Atlantoaxial Rotatory Subluxation

Umebayashi, Daisuke,Hara, Masahito,Nishimura, Yusuke,Wakabayashi, Toshihiko The Korean Neurosurgical Society 2014 Journal of Korean neurosurgical society Vol.55 No.5

A rare case of atlantoaxial rotatory subluxation occurred after pediatric cervical spine surgery performed to remove a dumbbell-shaped meningioma at the level of the C1/C2 vertebrae. This case is classified as a post-surgical atlantoaxial rotatory subluxation, but has a very rare morphology that has not previously been reported. Although there are several reports about post-surgical atlantoaxial rotatory subluxation, an important point of this case is that it might be directly related to the spinal cord surgery in C1/C2 level. On day 6 after surgery, the patient presented with the Cock Robin position, and a computed tomography scan revealed a normal type of atlantoaxial rotatory subluxation. Manual reduction was performed followed by external fixation with a neck collar. About 7 months after the first surgery, the subluxation became severe, irreducible, and assumed an atypical form where the anterior tubercle of C1 migrated to a cranial position, and the posterior tubercle of C1 and the occipital bone leaned in a caudal direction. The pathogenic process suggested deformity of the occipital condyle and bilateral C2 superior facets with atlantooccipital subluxation. A second operation for reduction and fixation was performed, and the subluxation was stabilized by posterior fixation. We encountered an unusual case of a refractory subluxation that was associated with an atypical deformity of the upper spine. The case was successfully managed by posterior fixation.

환추축 아탈구를 동반한 미분화 척추관절증-증례보고-

이원일,정인숙,허남연,한지아,목성균 대한재활의학회 2008 Annals of Rehabilitation Medicine Vol.32 No.3

Atlantoaxial subluxation in undifferentiated spondyloarthropathy is extremely rare and has not been reported. We describe a case of 27-year-old man who was diagnosed as undifferentiated spondyloarthropathy with atlantoaxial subluxation with an initial complaint of painful swelling of right 1st metatarsophalangeal joint and posterior neck pain. Roentgenograms showed sclerotic change and increased hazziness in right 1st metatarsophalangeal joint. Magnetic resonance images and roentgenograms of the cervical spine showed inflammation of odontoid process and atlantoaxial subluxation. Bone scan showed hot uptakes in left sacroiliac joint, right 1st & 4th metacarpophalangeal joints and 1st metatarsophalangeal joint. HLA-B27 gene was positive. Spontaneous atlantoaxial subluxation and undifferentiated spondyloarthropathy was diagnosed and conservatively treated with oral medication. Currently, there is no definite neurological sign. Early recognition and awareness of potential clinical complications is important in preventing compressive damage on central nervous system

고리중쇠관절 부분탈구가 말초관절염보다 선행된 류마티스관절염

장재호 ( Je Ho Chang ),김용훈 ( Yong Hoon Kim ),윤보영 ( Bo Young Yoon ) 대한류마티스학회 2007 대한류마티스학회지 Vol.14 No.1

We report here on a case of rheumatoid arthritis (RA) that progressed from the spine to the peripheral joints. In RA, the involvement of the cervical spine usually correlates with the progressive erosion of peripheral joints, such as the hand or foot, and the elevation of disease activity. Generally, it takes over 2 years of rheumatoid involvement of the cervical spine to cause laxity of the transverse ligament. The common types of rheumatoid cervical spine are anterior atlantoaxial subluxation, vertical subluxation and subaxial subluxation. We describe a 61-year-old woman with only neck pain initially. An MRI of the cervical spine showed atlantoaxial subluxation with features of the rheumatoid involvement. Arthritis later developed in both hands and symmetrically in other peripheral joints. She was diagnosed as having RA. This is the first case report of RA presenting initially as atlantoaxial subluxation.

Surgical Stabilization of a Craniocervical Junction Abnormality with Atlantoaxial Subluxation in a Dog

하정호,정창수,최성재,정주현,우흥명,강병재 한국임상수의학회 2018 한국임상수의학회지 Vol.35 No.1

A 7-month-old female Bichon Frise, displaying neck pain and ataxia, was diagnosed with craniocervicaljunction abonormality (CJA), along with atlantoaxial subluxation. Surgical fixation of the atlantoaxial subluxation wasperformed, using cortical screws and bone cement, along with an odontoidectomy. After surgery, nonsteroidal antiinflammatorymedication was prescribed for pain control, and a loose bandage was applied to the neck. Mild ambulatorytetraparesis remained 1 week after surgery. Three weeks after surgery, the range of neck motion was near normal,and clinical signs had improved. CJA should be considered as a differential diagnosis in dogs with cervical myelopathy. Surgical stabilization using cortical screws and bone cement through a ventral approach can be successful in dogswith CJA and atlantoaxial subluxation.

제 1-2 경추간 아탈구에 의한 경추 척수증에 시행한 분절 나사 고정술을 이용한 간접 감압술

김윤종(Yoon Jong Kim),김경환(Kyeong Hwan Kim),원종화(Jong Hwa Won),민학진(Hak Jin Min),윤의성(Ui Seong Yoon),염진섭(Jin Sup Yeom) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.6

제 1-2 경추간 아탈구로 인한 심한 척수 압박과 척수증이 있는 경우, 수술의 목적은 척수를 감압하고 견고한 내고정 및 유합을 얻는 것이다. 척수를 압박하는 골조직을 절제하는 직접 감압술에는 경구 감압술과 제 1 경추 후궁 절제술이 있으나, 이들은 합병증 발생률이 높거나 골 유합을 얻기 힘들다는 단점이 있다. 간접 감압은 골조직 절제 없이 아탈구만을 정복하여 내고정함으로써 척수를 감압하는 것으로, 심한 척수 압박으로 인한 척수증에 대한 간접 감압은 국내에서는 보고된 바 없다. 저자들은 제 1-2 경추간 아탈구로 인한 심한 척수증에 대해 제 1-2 경추간 분절 나사 고정술을 이용한 간접 감압술을 시행하여 만족할 만한 정복 및 감압과 척수증의 호전을 얻었기에 이를 보고하고자 한다. The main aims of surgery for severe cord compression and myelopathy caused by atlantoaxial subluxation are decompression of the spinal cord and achievement of rigid fixation and fusion. Direct decompression by resecting the bony structures that compress the spinal cord includes transoral decompression and resection of the posterior arch of the atlas. The shortcomings of these procedures are a high complication rate and a relatively low rate of union. Indirect decompression can be performed by a reduction of the subluxation and fixation without bone resection. To the best of our knowledge, there are no domestic reports on the use of indirect decompression for severe cord compression and myelopathy for atlantoaxial subluxation. We report a case of a patient that had atlantoaxial subluxation and severe myelopathy; satisfactory reduction of the subluxation and decompression with an improvement in the myelopathy symptoms was achieved by indirect decompression using segmental screw fixation.

상위 척추 동맥을 동반한 제1~2경추간 진구성 회전 아탈구: 제1경추 외측괴 나사와 제2경추 후궁 나사를 이용한 유합술 -1예 보고-

김경환 ( Kyeong Hwan Kim ),염진섭 ( Jin Sup Yeom ),박건우 ( Kun Woo Park ),홍순우 ( Soon Woo Hong ),장봉순 ( Bong Soon Chang ),이춘기 ( Choon Ki Lee ) 대한골절학회 2007 대한골절학회지 Vol.20 No.1

저자들이 아는 한, 제1∼2경추간 아탈구의 후방 유합술에 있어서 제2경추 후궁 나사와 제1경추 외측괴 나사를 이용한 분절 나사 고정술은 국내에서 보고된 바 없다. 저자들은 제1∼2경추간 진구성 회전 아탈구로 인해 후방 유합술을 요하였으나, 골다공증으로 인해 강선 고정술을 사용하기 곤란하였고, 제2경추의 특이한 형태로 인해 경관절 나사 고정술이나 척추경 나사 삽입술도 사용할 수 없었던 1예에서 제2경추 후궁 나사와 제1경 외측괴 나사를 이용한 분절 나사 고정술을 시행하였던 치험 결과를 보고하고자 한다. To the best of our knowledge, there has been no domestic report on posterior atlantoaxial fusion with segmental screw fixation using C2 laminar screws and C1 lateral mass screws for atlantoaxial subluxation. We report the result of this operation performed in a patient with old atlantoaxial rotary subluxation who required posterior fusion. We chose this technique in this patient because wire fixation was not suitable due to osteoporosis, and transarticular screw fixation and use of C2 pedicle screws were not feasible due to the peculiar bony anatomy of the axis.

류마티스 관절염과 HLA-B27과의 연관성에 관한 연구

고희관 ( Hee Kwan Koh ),오광택 ( Kwang Taek Oh ),송용호 ( Yong Ho Song ),정자헌 ( Ja Hun Jung ),김태환 ( Tae Hwan Kim ),김동욱 ( Dong Yook Kim ),전재범 ( Jae Bum Jun ),정성수 ( Sung Soo Jung ),이인홍 ( In Hong Lee ),배상철 ( Sang 대한류마티스학회 1996 대한류마티스학회지 Vol.3 No.1

Objective: In rheumatoid arthritis(RA) patients, HLA-B27 has been mainly found with the same frequency as in the normal population. An increased frequency of HLA-B27 in RA has, however, repeatedly been found in northern Sweden and in Filand. The results concerning the association of HLA-B27 to the outcome of the disease have been contradictory in RA. In RA, the presence of HLA-B27 has shown to be a prognostic index for cervical spine subluxation. There has been no report regarding the association between RA and HLA-B27 in the Korean population. Methods: 188 patients with RA were randomly selected from the patients who were diagnosed at Rheumatism Center of Hanyang University Hospital from October 1994 to June 1995 to establish the frequency of HLA-B27 in RA and to investigate the possible influence and prognostic significance on clinical outcome including atlantoaxial subluxations. Results: The results were as follows: 1) HLA-B27 was present in 12.2% of the RA patients studied. The relative risk (RR) and etiologic fraction (EF) of HLA-B27 were 5.99 and 0.1019 respectively. 2) The rheumatoid factor was positive in 79.8% of the total patients, 73.9% in HLA-B27 positive patients, and 80.6% in HLA-B27 negative patients. HLA-B27 was not associated with the presence of rheumatoid factor in this study. 3) HLA-B27 was not associated with the duration of morning stiffness, Ritchie index, extraarticular manifestations, the number of swollen joints, ARA functional class, ESR. C-reactive protein, or hemoglobin. HLA-B27 was not associated with the positivity of ANA and antiperinuclear factor. 4) HLA-B27 was not associated with the positive rate of erosion and Steinbrocker class in peripheral joints. 5) Atlantoaxial subluxation was present in 13% of HLA-B27 positive patients and 17% of HLA-B27 negative patients. The involvement of atlantoaxial joint including narrowing of lateral facet joints was 26.1% in HLA-B27 positive patients and 20.6% in HLA-B27 negative patients. Subaxial subluxation was presented in only 1 case in HLA-B27 negative group of total patients. HLA-B27 was not associated with the cervical changes in RA. Conclusions: An increased freuency of HLA-B27 in RA patients was significantly found in Korea (RR=5.99, EF=0.1019). However, patients with HLA-B27 had a similiar clinical profile to patients without HLA-B27 and HLAB27 positivity did not further contribute to the severity with respect to clinical and laboratory variables or to radiological progression in peripheral joints or cervical spine.

Congenital Anomaly of the Atlas Misdiagnosed as Posterior Arch Fracture of the Atlas and Atlantoaxial Subluxation

박영,김성민,Yun Tae Lee,유주형,오현철,하중원,성승용,윤한국,장지훈,정정열 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.1

Partialor complete absence of the posterior arch of the atlas is a well-documented anomaly but a relatively rare condition. This condition is usually asymptomatic so most are diagnosed incidentally. There have been a few documented cases of congenital defects of the posterior arch of the atlas combined with atlantoaxial subluxation. We report a very rare case of congenital anomaly of the atlas combined with atlantoaxial subluxation, that can be misdiagnosed as posterior arch fracture.

제2경추 관절하 나사와 제1경추 외측괴 나사를 이용한 제1-2경추간 고정술

원종화(Jong Hwa Won),염진섭(Jin Sup Yeom),민학진(Hak Jin Min),윤의성(Ui Seong Yoon),장봉순(Bong-Soon Chang),이춘기(Choon-Ki Lee) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.6

제1-2경추간 분절 나사 고정술은 제1-2경추간 아탈구의 치료에 유용한 수술 방법이다. 현재로서는 제1경추에는 외측괴 나사를, 제2경추에는 척추경 나사를 사용하는 방법이 표준적이나, 후자는 삽입 도중 척추동맥 손상이 발생할 수 있다는 심각한 단점을 가지고 있다. 저자들은 최근에 1 ㎜ 간격 CT와 시뮬레이션 소프트웨어를 이용한 연구에서 제2경추 척추경 나사보다 척추동맥 손상의 위험이 적은 새로운 궤도인 제2경추 관절하 나사를 제안한 바 있다. 저자들은 제2경추 관절하 나사와 제1경추 외측괴 나사를 사용한 제1-2경추간 분절 나사 고정술의 첫 번째 증례를 보고하고자 한다. 환자는 제1-2경추간 아탈구와 척수증을 가지고 있었으며, 수술 후 만족할 결과를 얻었다. Segmental screw fixation is a useful procedure for the surgical treatment of atlantoaxial subluxation. Currently, C1 lateral mass screws and C2 pedicle screws are the standard screws used in this procedure. However, the C2 pedicle screw can cause serious complications such as vertebral artery injury. Recently we suggested a new trajectory for the C2 screw, the subarticular screw, which has a lower probability of vertebral artery injury compared with the pedicle screw, based on a study using 1 mm-sliced CT scan images and simulation software. We report the first case of segmental screw fixation using C2 subarticular screws along with C1 lateral mass screws. The patient had atlantoaxial subluxation and myelopathy and showed satisfactory results after surgery.

비류마티스 환축추 불완전탈구에서 발생한 경부척수병

김진옥,김효정,윤동주,고영채,장상현,윤수진,오건세,이수주 대한신경과학회 2012 대한신경과학회지 Vol.30 No.3

Degenerative pannus arising from the atlanto-axial articulation is a rare entity, which is associated with chronic atlanto-axial instability in degenerative arthropathies. Due to cervical instability and the mass effect on the spinal cord, it can produce severe neck pain and compressive myelopathy. We report a case of cervical myelopathy resulting from non-rheumatoid atlanto-axial subluxation. The posterior stabilization provided excellent neurological improvement and pannus regression. Early recognition of this condition is important as the clinical condition will deteriorate without surgical interventions.