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Atlantoaxial Instability Medication

  • Author: Daniel P Leas, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
 
Updated: Feb 03, 2015
 
 

Medication Summary

No role currently exists for medications in the treatment of AAI. Whereas nonsteroidal anti-inflammatory drugs (NSAIDs) are used in atlantoaxial rotary subluxation to control the inflammation, evidence to support this practice is lacking.

Kaito et al found a de novo rate of cervical lesions of 8% in a small retrospective study of 38 RA patients receiving some form of biologic therapy. There was still a high disease progression rate in patients that were already on the spectrum of cervical disease (81%).[15, 16]

Unfortunately, an intervention-versus-control trial is ethically impossible, given the known benefits of biologic therapy in other targets of rheumatoid disease. Thus, the impact of these agents on development and cervical progression has yet to be truly determined. Long-term case studies compared to historical matched controls will be required to make any further comparison.

 
Contributor Information and Disclosures
Author

Daniel P Leas, MD Post-Doctoral Research Fellow, Resident Physician, Department of Orthopaedic Surgery, Carolinas Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Daxes M Banit, MD Partner, Middle Georgia Orthopaedic Surgery and Sports Medicine

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

Disclosure: Nothing to disclose.

Daniel Murrey, MD Co-President, OrthoCarolina

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

Disclosure: Nothing to disclose.

Bruce V Darden, II, MD Director, Spine Surgery Fellowship, OrthoCarolina Spine Center; Spine Teaching Staff, Orthopaedic Residency Program, Carolinas Medical Center

Bruce V Darden, II, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Scoliosis Research Society, Cervical Spine Research Society, AO North America, International Society for the Advancement of Spine Surgery, Lumbar Spine Research Society, North Carolina Medical Society, American Medical Association, North American Spine Society, Southern Medical Association, Southern Orthopaedic Association, American Society of Neurophysiological Monitoring, North Carolina Orthopaedic Association, North Carolina Spine Society, Scoliosis Association, Inc, Spine Society of Europe

Disclosure: Received consulting fee from Synthes for speaking and teaching; Received grant/research funds from Synthes for other; Received royalty from Stryker for other; Received consulting fee from Stryker for consulting; Received consulting fee from 4Web for consulting; Received consulting fee from Spineguard for consulting; Received ownership interest from BioMedFlex for other.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

William O Shaffer, MD Orthopedic Spine Surgeon, Northwest Iowa Bone, Joint, and Sports Surgeons

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

Disclosure: Received royalty from DePuySpine 1997-2007 (not presently) for consulting; Received grant/research funds from DePuySpine 2002-2007 (closed) for sacropelvic instrumentation biomechanical study; Received grant/research funds from DePuyBiologics 2005-2008 (closed) for healos study just closed; Received consulting fee from DePuySpine 2009 for design of offset modification of expedium.

Chief Editor

Jeffrey A Goldstein, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Director of Spine Service, Director of Spine Fellowship, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center

Jeffrey A Goldstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, North American Spine Society, Scoliosis Research Society, Cervical Spine Research Society, International Society for the Study of the Lumbar Spine, AOSpine, Society of Lateral Access Surgery, International Society for the Advancement of Spine Surgery, Lumbar Spine Research Society

Disclosure: Received consulting fee from Medtronic for consulting; Received consulting fee from NuVasive for consulting; Received royalty from Nuvasive for consulting; Received consulting fee from K2M for consulting; Received ownership interest from NuVasive for none.

Additional Contributors

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) Professor, Department of Orthopedic Surgery, University of Texas Medical School at Houston

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

Disclosure: Nothing to disclose.

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Transverse ligament holds dens against anterior arch of atlas.
Midsagittal section of upper cervical spine. Note landmarks for measuring anterior atlantodental interval (AADI) and posterior atlantodental interval (PADI).
Shown are 4 types of atlantoaxial rotatory subluxation.
 
 
 
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