• The Korean Journal of Pain
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• v.12 no.2
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• pp.231-234
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• 1999

Until several years ago we didn't think seriously about cervical problems as a cause of headaches, but since the publication of articles by Bogduk et al they have gotten more attention. Cervical headaches are associated with movement abnormalities of the structures of the neck such as cervical nerve roots, discs, joints and soft tissues. Considering this, we thought that the atlanto-axial joint could be one of the causes of these headaches. Headaches originating from this joint can be recognized by the fact that the pain worsens with rotation of the head in the horizontal plane. Pain can also be referred to the frontal area or around the orbit. We did atlanto-axial joint blocks using a posterior approach on 10 patients who suffered from this type of headache. The results were promising with 9 out of 10 patients showing more than 50% improvement on the numeric rating scale. There were no serious complications observed. We concluded that the atlanto-axial joint block can be an effective procedure in treating this specific type of headache.

• The Korean Journal of Pain
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• v.21 no.1
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• pp.1-10
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• 2008

Spinal joint pain syndrome is composed of atlanto-occipital, atlanto-axial, facet, and sacro-iliac joints pain. The syndrome is characterized as referred pain which is originated from deep somatic tissues, which is quietly different from radicular pain with dermatomal distribution originated from nerve root ganglion. The prevalence of facet joint pain in patients with chronic spinal pain of cervical, thoracic, and lumbar regions has been known 56%, 42%, and 31% as in order. It is generally accepted in clinical practice that diagnostic blocks are the most reliable means for diagnosing spinal joints as pain generators. The sacroiliac joint has been shown to be a source of 10% to 27% of suspected cases with chronic low back pain utilizing controlled comparative local anesthetic blocks. The treatment of spinal joints ideally consists of a multimodal approach comprising conservative therapy, medical management, procedural interventions, and if indicated.

• Journal of Korean Neurosurgical Society
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• v.64 no.5
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• pp.837-842
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• 2021

An atlantoaxial subluxation from the unstable Os odontoideum by the failure of proper integrations between the embryological somites might be a commonly reported pathology. However, its suspicious origin or paralleled occurrence with other congenital anomalies of vertebral body might be a relatively rare phenomenon. The authors present two cases, who simply presented with clinical signs of prolonged, intractable cervicalgia without any neurological deficits, revealed this rare feature of C1-2 subluxation from the unstable, orthotropic type of Os odontoideum that coincide with congenitally fused cervical vertebral bodies between C2-3. Surprisingly, in one case, when traced from the lower cervical down to the thoracic-lumbar levels during the preoperative work-up process, was also compromised with multi-level butterfly vertebrae formations. Presented cases highlight the association of various congenital vertebrae anomalies and the rationale to fuse only affected joints.

• Journal of Korean Neurosurgical Society
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• v.48 no.4
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• pp.367-370
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• 2010

We present a case of posterior atlantoaxial screw-rod fixation in a patient with an aberrant vertebral artery (VA) course combined with bilateral high-riding VA. An aberrant VA which courses below the posterior arch of the atlas (C1) that does not pass through the C1 transverse foramen and without an osseous anomaly is rare. However, it is important to consider an abnormal course of the VA both preoperatively and intraoperatively in order to avoid critical vascular injuries in procedures which require exposure or control of the VA, such as the far-lateral approach and spinal operations.

• The Korean Journal of Pain
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• v.6 no.1
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• pp.96-99
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• 1993

The pathological basis for cervicogenic headache may lie within the cervical spine. Clinically patients with cervicogenic headache complain of unilateral pain radiating in an atypical fashion from the occipital region. Our clinic has successfully treated post-traumatic cervicogenic headache with C2 spinal ganglion block. The technique of fluoroscopic guided injection was used to locate the C2 spinal ganglion. This technique is facilitated by the constancy of the anatomical relationship between the C2 ganglion and the midpoint of the atlanto-axial joint. There are no major structures near the proximity of the ganglion.

• Archives of Craniofacial Surgery
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• v.25 no.2
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• pp.85-89
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• 2024

Postoperative atlantoaxial rotatory subluxation (AARS) is a rare complication that develops almost exclusively in children following oropharyngeal and otologic surgeries, proposing that oropharyngeal inflammatory responses and excessive head rotation are responsible factors. However, there have been no reports of AARS after excision of a nevus on the head and neck. Here, we present two cases of AARS following limited head rotation during simple nevus excision. Patient 1, a 9-year-old girl, complained of neck pain and limited range of motion after excision of the nevus on the neck. After 2 months, computed tomography and magnetic resonance imaging finally revealed AARS with a ruptured transverse atlantal ligament. A month of halo traction was required for the treatment. Patient 2, an 11-year-old girl, presented with immediate pain and limited neck extension after tissue expander insertion under the upper chest and excision of the nevus on her left cheek. The diagnosis was promptly made using cervical spine radiography. A cervical collar was applied for 1 month. Both patients recovered without any complications after treatment. This report highlights the importance of suspicion for AARS after surgery regardless of surgical duration or amount of head rotation.

• The Korean Journal of Physiology
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• v.24 no.1
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• pp.103-113
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• 1990

The role of cervical proprioceptors in the control of body posture was studied in bilaterally labyrinth-ectomized, decerebrate cats. The animals were suspended on hip pins with the neck extended horizontally. With this placement the EMG activities of extensor and flexor muscles of the upper extremities were observed by means of sinusoidal head rotator. The rotator can induce two kinds of neck movement: The one is 'pitch' which describes a rotatory neck motion to transverse axis of the body and mainly occurs at skull-C1 (atlantooccipital) joint and the other is 'roll', side-to-side relation of the neck to longitudinal axis, whose center is C1-C2 (atlanto-axial) joint. The following results were obtained. 1) Responses of EMG activity were closely dependent on the rotatory range of the neck. And the EMG activity was not changed during sustained neck torsion, eliciting a typical tonic neck reflex. 2) On pitching movement, the head-up rotation produced the excitation of bilateral triceps muscles, whereas the head-down rotation produced the inhibition. And the response of bilateral biceps muscles was the opposite to that of triceps. 3) On rolling movement, the side-up rotation of the head produced the excitation of ipsilateral triceps muscles and the inhibition of contralateral ones. And the response of biceps muscles was the opposite to that of triceps. 4) The minimum requirement of motion to evoke EMG activities in the upper extremities was $3.2^{\circ}{\sim}12.5^{\circ}$. These results have shown that the cervical proprioceptors produce tonic discharge on the upper brachial muscles, regulate the EMG activities of those muscles, and are very sensitive to neck rotation. And it can be stated that the cervical proprioceptors may play an important role in the control of body posture and movement.

• Journal of Korean Neurosurgical Society
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• v.63 no.2
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• pp.237-247
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• 2020

Objective : Fixation of the C1-2 segment is challenging because of the complex anatomy in the region and the need for a high degree of accuracy to avoid complications. Preoperative 3D-computed tomography (CT) scans can help reduce the risk of complications in the vertebral artery, spinal cord, and nerve roots. However, the patient may be susceptible to injury if the patient's anatomy does not match the preoperative CT scans. The intraoperative 3D image-based navigation systems have reduced complications in instrument-assisted techniques due to greater accuracy. This study aimed to compare the radiologic outcomes of C1-2 fusion surgery between intraoperative CT image-guided operation and fluoroscopy-guided operation. Methods : We retrospectively reviewed the radiologic images of 34 patients who underwent C1-2 fusion spine surgery from January 2009 to November 2018 at our hospital. We assessed 17 cases each of degenerative cervical disease and trauma in a study population of 18 males and 16 females. The mean age was 54.8 years. A total of 139 screws were used and the surgical procedures included 68 screws in the C1 lateral mass, 58 screws in C2 pedicle, nine screws in C2 lamina and C2 pars screws, four lateral mass screws in sub-axial level. Of the 34 patients, 19 patients underwent screw insertion using intraoperative mobile CT. Other patients underwent atlantoaxial fusion with a standard fluoroscopy-guided device. Results : A total of 139 screws were correctly positioned. We analyzed the positions of 135 screws except for the four screws that performed the lateral mass screws in C3 vertebra. Minor screw penetration was observed in seven cases (5.2%), and major pedicle screw penetration was observed in three cases (2.2%). In one case, the malposition of a C2 pedicle screw was confirmed, which was subsequently corrected. There were no complications regarding vertebral artery injury or onset of new neurologic deficits. The screw malposition rate was lower (5.3%) in patients who underwent intraoperative CT-based navigation than that for fluoroscopy-guided cases (10.2%). And we confirmed that the operation time can be significantly reduced by surgery using intraoperative O-arm device. Conclusion : Spinal navigation using intraoperative cone-beam CT scans is reliable for posterior fixation in unstable C1-2 pathologies and can be reduced the operative time.