• Journal of Korean Neurosurgical Society
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• v.55 no.5
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• pp.284-288
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• 2014

A rare case of atlantoaxial rotatory subluxation occurred after pediatric cervical spine surgery performed to remove a dumbbell-shaped meningioma at the level of the C1/C2 vertebrae. This case is classified as a post-surgical atlantoaxial rotatory subluxation, but has a very rare morphology that has not previously been reported. Although there are several reports about post-surgical atlantoaxial rotatory subluxation, an important point of this case is that it might be directly related to the spinal cord surgery in C1/C2 level. On day 6 after surgery, the patient presented with the Cock Robin position, and a computed tomography scan revealed a normal type of atlantoaxial rotatory subluxation. Manual reduction was performed followed by external fixation with a neck collar. About 7 months after the first surgery, the subluxation became severe, irreducible, and assumed an atypical form where the anterior tubercle of C1 migrated to a cranial position, and the posterior tubercle of C1 and the occipital bone leaned in a caudal direction. The pathogenic process suggested deformity of the occipital condyle and bilateral C2 superior facets with atlantooccipital subluxation. A second operation for reduction and fixation was performed, and the subluxation was stabilized by posterior fixation. We encountered an unusual case of a refractory subluxation that was associated with an atypical deformity of the upper spine. The case was successfully managed by posterior fixation.

• Journal of Veterinary Clinics
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• v.35 no.1
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• pp.30-33
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• 2018

A 7-month-old female Bichon Frise, displaying neck pain and ataxia, was diagnosed with craniocervical junction abonormality (CJA), along with atlantoaxial subluxation. Surgical fixation of the atlantoaxial subluxation was performed, using cortical screws and bone cement, along with an odontoidectomy. After surgery, nonsteroidal anti-inflammatory medication was prescribed for pain control, and a loose bandage was applied to the neck. Mild ambulatory tetraparesis remained 1 week after surgery. Three weeks after surgery, the range of neck motion was near normal, and clinical signs had improved. CJA should be considered as a differential diagnosis in dogs with cervical myelopathy. Surgical stabilization using cortical screws and bone cement through a ventral approach can be successful in dogs with CJA and atlantoaxial subluxation.

• Clinical Pain
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• v.18 no.2
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• pp.92-96
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• 2019

Torticollis is an abnormal, asymmetric head or neck position which usually caused by imbalance of paracervical muscles. The traumatic torticollis can be caused by following events; atlantoaxial rotatory subluxation, atlantoaxial dislocation, cervical vertebral fractures, and injury to the cervical musculature. Especially, acute traumatic atlantoaxial rotatory subluxation usually presents limitation of cervical range of motion without pain or neurologic deficit. We report a case of a 58 year-old man who developed the acute atlantoaxial rotatory subluxation right after the chiropractic therapy, which induced the limitation of cervical range of motion to 52.5% of normal range. The magnetic resonance image revealed the facture of the odontoid process and the partial injury in transverse ligaments of the atlas. He underwent intramuscular botulinum toxin injection and 10 days of continuous cervical traction 15 hours a day using a 5 kg weight. The range of the cervical motion restored up to 90.2% of normal range.

• Clinical and Experimental Pediatrics
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• v.56 no.12
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• pp.540-544
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• 2013

Down syndrome, the most common chromosomal abnormality, may be associated with various neurologic complications such as moyamoya syndrome, cervical spinal cord compression due to atlantoaxial subluxation, and basal ganglia damage, as well as epileptic seizures and stroke. Many cases of Down syndrome accompanied by isolated neurologic manifestations have been reported in children; however, Down syndrome with multiple neurologic conditions is rare. Here, we have reported a case of Down syndrome in a 10-year-old girl who presented with asymptomatic moyamoya syndrome, atlantoaxial subluxation with spinal cord compression, and basal ganglia calcification. To the best of our knowledge, this is the first report of Down syndrome, in a child, which was accompanied by these 3 neurologic complications simultaneously. As seen in this case, patients with Down syndrome may have neurologic conditions without any obvious neurologic symptoms; hence, patients with Down syndrome should be carefully examined for the presence of neurologic conditions.

• Journal of Veterinary Clinics
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• v.14 no.1
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• pp.126-130
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• 1997

10개월경의 그리폰 벤딘 수컷 강아지가 8개월경부터 점점 운동 실조 및 마비증상을 나타내어 머독대학 동물병원에 내원 하였다. 내원 했을 때 주변에 매우 민감한 반응과 경계를 늦추지 않았지만 호흡과 심박수 및 체온은 정상이었다. 일반 방사선 사진 및 척수조영사진(myelography)을 촬영하여 확인한 결과 환축추의 불안정에 따른 척수의 복측 압박을 확인할 수 있었다. 외과적 고정은 복측 접근을 통하여 2개의 키르크너 강선(Kirschner wire)과 자가골이식을 실시하였으며 8주동안 외부 고정을 하였다. 수술 후 5개월 동안 지켜본 결과 증상은 꾸준히 좋아졌으며 환축추 관절으 관절고정술(arthrodesis)은 완벽한 고정을 유지하고 있었다.

• Proceedings of the Korean Society of Veterinary Clinics Conference
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• 2008.05a
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• pp.126-126
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• 2008

• Journal of Korean Neurosurgical Society
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• v.58 no.1
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• pp.89-92
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• 2015

Rheumatoid arthritis (RA) is a chronic inflammatory disease involving multiple joints. The cervical spine is often affected, and cases involving atlantoaxial joint can lead to instability. Anterior atlantoaxial subluxation in RA patients can lead to posterior neck pain or occipital headache because of compression of the C2 ganglion or nerve. Here, we report the successful treatment of a RA patient with occipital radiating headache using pulsed radiofrequency therapy at the C2 dorsal root ganglion.

• 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.37 no.5
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• pp.380-382
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• 2005

We report a case of atlantoaxial subluxation with bilateral high-riding vertebral artery with narrow isthmus. Because of the potential risk of bilateral vertebral artery injury, we performed atlantoaxial fixation using rod and screw instead of transarticular screw fixation. Although postoperative computed tomography reconstruction demonstrated slight breach of bilateral vertebral artery groove, postoperative angiography showed no evidence of vertebral artery injury. Though technically demanding, atlantoaxial fixation using rod and screw can be a one of the treatment options for atlantoaxial instability with bilateral high riding vertebral artery.

• Journal of Korean Neurosurgical Society
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• v.59 no.6
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• pp.590-596
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• 2016

Objective : Rheumatoid arthritis (RA) is a systemic disease that can affect the cervical spine, especially the atlantoaxial region. The present study evaluated the risk factors for atlantoaxial subluxation (AAS) development and progression in patients who have undergone surgical treatment. Methods : We retrospectively analyzed the data of 62 patients with RA and surgically treated AAS between 2002 and 2015. Additionally, we identified 62 patients as controls using propensity score matching of sex and age among 12667 RA patients from a rheumatology registry between 2007 and 2015. We extracted patient data, including sex, age at diagnosis, age at surgery, disease duration, radiographic hand joint changes, and history of methotrexate use, and laboratory data, including presence of rheumatoid factor and the C-reactive protein (CRP) level. Results : The mean patient age at diagnosis was 38.0 years. The mean time interval between RA diagnosis and AAS surgery was $13.6{\pm}7.0$ years. The risk factors for surgically treated AAS development were the serum CRP level (p=0.005) and radiographic hand joint erosion (p=0.009). The risk factors for AAS progression were a short time interval between RA diagnosis and radiographic hand joint erosion (p<0.001) and young age at RA diagnosis (p=0.04). Conclusion : The CRP level at RA diagnosis and a short time interval between RA diagnosis and radiographic hand joint erosion might be risk factors for surgically treated AAS development in RA patients. Additionally, a short time interval between RA diagnosis and radiographic hand joint erosion and young age at RA diagnosis might be risk factors for AAS progression.