Atlantoaxial Instability (Atlantoaxial Subluxation) Follow-up

Updated: May 21, 2021
  • Author: Chris G Koutures, MD, FAAP; Chief Editor: Craig C Young, MD  more...
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An abnormal ADI on lateral flexion-extension radiographic views is an absolute contraindication to participation in contact sports. [9] Noncontact exercise is permitted, although long-term data about the absolute risk are lacking.

Identified anomalies of the odontoid process represent another absolute contraindication to participation in contact sports, as does a history of cervical fusion or a previous unstable upper-cervical fracture.

The clinician must emphasize to patients with AAI that they need to refrain from activities that place the neck in extremes of flexion and extension.

In the Special Olympics, asymptomatic individuals with AAI may be prohibited from participating in several activities that are thought to have a theoretically increased risk of cervical cord injury. [6] These include gymnastics, diving, the pentathlon, swimming with the butterfly stroke, swimming with a diving start, high jumping, soccer, and performing certain warm-up exercises. Since these restrictions are no longer national, individual state Special Olympic organizations should be contacted for current guidance.

An experienced spinal surgeon or a consultant well versed in the demands of the particular activity should manage all return-to-play considerations.

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Resource Center Exercise and Sports Medicine