Atlantoaxial Instability Follow-up

  • Author: Daxes Banit, MD; Chief Editor: Mary Ann E Keenan, MD   more...
 
Updated: May 13, 2010
 

Further Inpatient Care

  • Special care should be taken to avoid excessive flexion or extension of the neck.
  • Neutral positioning of the neck should be maintained during all surgeries, especially during otorhinolaryngologic procedures. Care also should be taken during anesthetic administration to avoid trauma to the atlantoaxial joint.
  • Children should be monitored closely postoperatively for any signs of neurologic involvement.
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Further Outpatient Care

  • Individuals with Down syndrome, infections of the head and neck, or any other predisposing factors should be monitored carefully for neurologic symptoms indicative of symptomatic AAI.[30]
    • In individuals with Down syndrome and an ADI of greater than 5 mm, the recommendation is to avoid contact sports or activities with high risk of flexion injury.
    • When the ADI is more than 10 mm or neurologic findings develop, a fusion is recommended.
  • Regular assessments of the history and physical examinations, including evaluations before participation in sports, are recommended to detect neurologic involvement.
  • Patients also should be monitored carefully for development of symptoms, though the association between AAI and neurologic symptoms is unclear.
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Complications

  • Spinal cord compression can arise or worsen if susceptible patients are subjected to extreme ranges of motion.
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Prognosis

  • Prognosis is good for patients with symptomatic AAI in whom posterior spinal fusion is successful and function returns.
  • Surgery has been demonstrated to relieve pain in 95% of patients and decrease myelopathy in 74% of patients, depending on the severity of symptoms and the cause of instability.
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Patient Education

  • Family members should be aware of neurologic symptoms indicative of symptomatic AAI.
  • For excellent patient education resources, visit eMedicine's Back, Ribs, Neck, and Head Center. Also, see eMedicine's patient education article Torticollis.
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Contributor Information and Disclosures
Author

Daxes Banit, MD  Spine Fellow, Charlotte Orthopedic Specialists, PA

Daxes Banit, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel Murrey, MD  Clinical Faculty, Department of Orthopedic Surgery, Carolinas Medical Center; Consulting Surgeon, Presbyterian Orthopedic Hospital; Co-President, OrthoCarolina

Daniel Murrey, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Physician Executives, American Medical Association, North American Spine Society, and North Carolina Medical Society

Disclosure: Nothing to disclose.

Bruce Darden II, MD  Director, Spine Surgery Fellowship, Charlotte Spine Center

Bruce Darden II, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, North American Spine Society, North Carolina Medical Society, Scoliosis Research Society, Southern Medical Association, and Southern Orthopaedic Association

Disclosure: Synthes Consulting fee Speaking and teaching; Synthes Grant/research funds Other; Synthes fellowship support Other; Stryker Royalty Other; Stryker Consulting fee Consulting; Orthovita Ownership interest Consulting

Specialty Editor Board

James F Kellam, MD  Vice-Chair, Department of Orthopedic Surgery, Director of Orthopedic Trauma and Education, Carolinas Medical Center

James F Kellam, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

William O Shaffer, MD  Professor, Vice-Chairman and Residency Program Director, Department of Orthopedic Surgery, University of Kentucky at Lexington

William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, International Society for the Study of the Lumbar Spine, Kentucky Medical Association, Kentucky Orthopaedic Society, North American Spine Society, Southern Medical Association, and Southern Orthopaedic Association

Disclosure: DePuySpine 1997-2007 (not presently) Royalty Consulting; DePuySpine 2002-2007 (closed) Grant/research funds SacroPelvic Instrumentation Biomechanical Study; DePuyBiologics 2005-2008 (closed) Grant/research funds Healos study just closed; DePuySpine 2009 Consulting fee Design of Offset Modification of Expedium

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD  Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania

Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association

Disclosure: Nothing to disclose.

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The transverse ligament holds the dens against the anterior arch of the atlas.
A midsagittal section of the upper cervical spine. Note the landmarks for measuring the anterior atlantodens interval and the posterior atlantodens interval.
The 4 types of atlantoaxial rotatory subluxation.
 
 
 
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