Diagnosis and treatment of atlantoaxial dislocation and atlantoaxial subluxation in India (2023)

FAQs

What is the diagnosis and treatment of atlantoaxial subluxation? ›

Indications for treatment of atlantoaxial subluxation include pain, neurologic deficits, and potential spinal instability. Treatment includes symptomatic measures and cervical immobilization, usually beginning with a rigid cervical collar.

Atlantoaxial subluxation is usually diagnosed with plain neck x-rays. A neutral and forwarded flexed neck x-ray is best as it can demonstrate misalignment. A special radiographic measurement is used called the ADI (5).

Treatment of Atlantoaxial Subluxation

Treatment includes symptomatic measures and cervical immobilization, usually beginning with a rigid cervical collar. Urgency of treatment is generally based on symptoms or presence of cord abnormalities on MRI in susceptible patients.

Use of computed tomography (CT) can provide additional information regarding the stability of the atlantoaxial joint. Measuring displacement of defining rotation may be difficult on plain radiographs. Fine-cut CT with reformatting can be used for measuring the amount of displacement.

During physical examinations, subluxation is detected by palpation of the glenohumeral joint. The extent of shoulder subluxation can be quantified by the distance from the acromion to the humeral head, using fingerbreadth, caliper, or tape.

The treatment goals for persons with AAI are to protect the spinal cord, stabilize the spinal column, decompress neural tissue, and reduce any deformity. In most cases, the injury is purely ligamentous and unlikely to heal. Therefore, these injuries are typically treated with posterior C1-2 fusion.

Your chiropractor may perform adjustments to correct any subluxations, which involve gentle and usually painless thrusts that realign faulty joints and allow the body to heal. Combined with proper spinal care, this can prevent VSC from progressing into a more serious condition.

Treatment. If you suspect that you may have a spinal subluxation, the most recommended course of treatment is to visit a chiropractor. However, for minor cases relief can be achieved with stretches, over-the-counter pain medication, rest, and cold compresses.

Subluxation is an essential entity of traumatic subaxial cervical spinal injuries. There is a varying degree of slippage of the body of one vertebra relative to the adjacent vertebra, owing to ligamentous injury and the jumped facets, with, therefore, a high predisposition for injury to the spinal cord.

Trauma as the sole cause of atlantoaxial instability is a unique entity, usually resulting from a disruption of the transverse, alar, or apical ligaments. This type of injury is commonly associated with head trauma. Fractures of C1 or C2 also are traumatic causes of atlantoaxial instability.

Where is atlantoaxial subluxation seen? ›

Atlantoaxial subluxation or odontoid erosion, as seen in adult rheumatoid arthritis, is common in juvenile-onset adult-type (seropositive) rheumatoid arthritis but is uncommon in Still's disease. In Still's disease the apophyseal joints are involved, with ankylosis beginning in the upper cervical spine.

change in bowel or bladder control. neck pain or stiffness, or their head stays tilted. new weakness or they become fatigued more easily. a decrease in their activity level or function.

If the C1 or C2 vertebra is out of place, they can be placing undue pressure on the brainstem, causing it to send improper signals to the brain. The brain may think the body is in motion when it is not actually moving, leading to the symptoms of vertigo.

It has been reported that death is common in patients with RA once myelopathy develops in the patients with cervical spine involvement. Thirty-day mortality has been reported to be as high as 13% and 60% at 4 years in patients with advanced cervical disease.

Subluxations can lead to neurological conditions due to the pressure of the adjacent nerves. Subluxations over time will lead to negative affects on the discs, bones, and surrounding tissues. If left untreated for too long this damage becomes irreversible.

You might need surgery if you have repeated episodes of subluxation. Your surgeon can fix any problems that are making your shoulder joint unstable. This includes: ligament tears.

Subluxation of the shoulder is treated with rest, ice packs and NSAID's to reduce the pain and inflammation. You may be referred to physical therapy for shoulder strengthening exercises to help prevent recurrence.

Although overall motion is probably not affected, chiropractic reconstructive care for a phase one subluxation can take from 6 to 18 months.

Congenital Causes

Certain congenital conditions are associated with craniocervical region abnormalities that predispose these populations to developing atlantoaxial dislocation. One particularly well-studied condition is Down syndrome.

What are the symptoms of atlantoaxial joint injury? ›

A unilateral neck pain occurs with the slightest head rotation. The pain ascends unilaterally to the occiput, the parietal skull and sometimes even to the eye. Visual problems often leading to an ophthalmologic work up. A painful audible crepitation with head rotation.

Most commonly, subluxations are corrected easily with physical therapy treatment.

Dislocation is injury to a joint that causes adjoining bones to no longer touch each other. Subluxation is a minor or incomplete dislocation in which the joint surfaces still touch but are not in normal relation to each other.

PHASE 4 DEGENERATION

In the final stage of the four phases of subluxation degeneration, quality and longevity of life in the patient is decreased. Bone and neurological damage are permanent at this point, as the vertebra become fused.

Rest is needed to help the joint heal. Ice and elevation can both reduce swelling and pain, but compression might actually make pain worse. After an initial trauma or injury, exercises to improve range of motion and strength can be incorporated under the care of a medical professional.

Full range of motion usually returns after six to eight weeks. Strength usually returns in three months.

While complete dislocations often need to be guided back into place, subluxations (as long as the joint remains in alignment) can heal on their own with proper rest, ice, elevation, anti-inflammatory medication (RICE) and a splint or brace for added support and stability.

Both dislocations and subluxations can be painful, irritating, infuriating, and occasionally debilitating problems. However, they don't need to ruin your life and can — with patience, effort, trust, and time — be managed. Not necessarily completely eliminated, but managed.

As time goes on and the uncorrected subluxation settles, the damage to the nerve gets progressively worse different stages of subluxation degeneration set in. Regular visits to a licensed chiropractor can help to reduce the effects of subluxation and may be necessary maintain good health and physical fitness.

Anterior cervical discectomy and fusion (ACDF) surgery involves removing the C5-C6 intervertebral disc to relieve pressure on the spinal cord or C6 nerve root. The disc is replaced by an implant or bone graft, allowing biological fusion of the adjacent C5 and C6 vertebrae.

What is the mortality of atlantoaxial subluxation? ›

Nonunion rates have been reported to be up to 40% and mortality up to 35%, and poor functional outcomes are common.

Atlantoaxial instability (AAI), also known as atlantoaxial subluxation, is radiologically identified increased mobility or laxity between the body of the first cervical vertebra (atlas) and the odontoid process of the second cervical vertebra (axis) (see the image below).

type I: the atlas is rotated on the odontoid with no anterior displacement. type II: the atlas is rotated on one lateral articular process with 3 to 5 mm of anterior displacement. type III: comprises rotation of the atlas on both lateral articular processes with anterior displacement greater than 5 mm.

Atlantoaxial subluxation is misalignment of the 1st and 2nd cervical vertebrae, which may occur only with neck flexion. . This disorder is very rare.

The most frequent symptom is cervical pain accompanied by torticollis with neck stiffness. The pain may radiate by nerve compression to the occipital region, face, and ears. Patients present with painful torticollis; in some cases, they mention or suffer from upper airway infections.

Atlantoaxial (AA) subluxation (AA luxation, AA instability) usually results from congenital malformation or trauma to the associated bones, joint, and/or supporting ligamentous structures involved the articulation of the atlas (C1) and axis (C2).

CCI and AAI are often diagnosed via the patient's symptoms and either a hands-on manual test by the doctor or therapist or diagnostic imaging. However, realize that for many patients, getting the right testing to cinch the diagnosis is difficult.

In order for cervical instability to be diagnosed, a physical exam combined with magnetic resonance imaging (MRI) scans, computerized tomography (CT) scans, and/or digital X-ray imaging, can help us see what's happening in and around the spine: identifying any areas of spinal subluxation.

A chiropractic doctor can treat conditions such as musculoskeletal pain, migraines, and sciatica with spinal adjustments. Upper cervical chiropractic is a subspecialty of chiropractic care that focuses on the 2 upper vertebrae of the spine: the atlas (C1) and the axis (C2).

Medications may also be a part of your cervical vertigo treatment plan. These medications may include: Muscle relaxants to reduce neck tightness. Pain relievers to ease discomfort.

What kind of doctor treats cervical instability? ›

If you have a craniocervical junction disorder, you may receive treatment from a neurologist, orthopedic surgeon, or neurosurgeon. In addition, physiatrists and pain management specialists, along with physical therapists and occupational therapists, can help reduce pain and improve your quality of life.

Special radiographic studies are required which include upper cervical MRI or rotatory CT scan. In addition, there are additional studies that involve the patient moving during the examination. These studies are useful to identify instability.

Craniocervical instability, if left untreated, can result in a progression in symptoms and injury to the cervical discs, facets, muscles, and nerves. In severe cases, patients are housebound due to their level of dysfunction and symptoms. Employment, relationships, and joy often times are eroded.

A shoulder dislocation is more extreme than a shoulder subluxation. In this case, the ball and socket become completely separated.

If possible, go to the emergency room instead of an urgent care or other clinic if you experience a dislocation. The ER is the best place to go because healthcare providers in the emergency room can get you any imaging tests and any medication you'll need before and after they put your joint back into alignment.

Treatment. If you suspect that you may have a spinal subluxation, the most recommended course of treatment is to visit a chiropractor. However, for minor cases relief can be achieved with stretches, over-the-counter pain medication, rest, and cold compresses.

Your brain and nervous system control every cell, tissue and organ within your body. It is essential that this communication is undisturbed so optimal health can be achieved. Only a chiropractic examination can detect an ASC, and only a precise chiropractic adjustment can reduce their effect to your nervous system.

How is subluxation corrected? Chiropractors are specialists in correcting subluxation and other misalignments. A chiropractor can restore the misaligned vertebrae to their proper position in the spinal column. They do this manually by using the chiropractic procedure known as spinal adjustment.

Magnetic resonance imaging (MRI) of the spine- provides details on the pattern of soft tissue injury (ligaments) and damage to the spinal cord (compression, transection, central cord syndrome).

How do you fix C1 C2 subluxation? ›

To adjust your atlas bone, a chiropractor who specializes in upper cervical care will lead you through a series of gentle corrections. Your chiropractor may then show you at-home exercises to support your vertebral column. It's important not to attempt adjustment on your own without a professional modeling it first.

After you have been holding your adjustment for about six weeks your body will go into the “resting” phase of the healing cycle. During this time you can experience less expression of symptoms and an overall feeling of well-being.

Rest is needed to help the joint heal. Ice and elevation can both reduce swelling and pain, but compression might actually make pain worse. After an initial trauma or injury, exercises to improve range of motion and strength can be incorporated under the care of a medical professional.

Spinal subluxations can occasionally clear up on their own, but when they don't, chiropractic treatment should be sought out. A series of chiropractic adjustments can change the position and motion of the spinal bones so that they no longer impinge on adjacent nerves.

Additionally, chiropractors are trained and certified to diagnose and treat spinal subluxation. They apply quick and gentle force to the affected joint to remove the subluxation and correct the alignment. This will instantly increase your range of motion and improve your overall spinal function.

The maximal extent of the subluxation must be taken into account when the possible compression of neural structures is evaluated by MRI.

These are common symptoms: Pain and stiffness in the neck, back, or lower back. Burning pain that spreads to the arms, buttocks, or down into the legs (sciatica) Numbness, cramping, or weakness in the arms, hands, or legs.