What Is Atlantoaxial Subluxation?

Atlantoaxial subluxation affects the cervical spine.

Atlantoaxial subluxation (or atlantoaxial instability) is a condition in which the vertebrae of the cervical spine are misaligned, usually as a result of trauma. The condition can range from fairly mild to severe. In the latter case, the loosened spine may compress the spinal cord, leading to irreversible neurological damage.

Causes

Atlantoaxial subluxation has several causes. Most often, the condition is brought on by major neck trauma resulting from an injury or accident. Adults suffering from rheumatoid arthritis may also experience atlantoaxial subluxation. Other causes include serious respiratory illnesses such as pneumonia, spinal surgery and congenital (present at birth) conditions rendering poor muscle or connective tissue tone, as seen in Down's Syndrome.

Symptoms

Various symptoms can accompany atlantoaxial subluxation. The neck may have a twisted appearance, although this trait is not present in all sufferers. Frequent headaches or pain in the cervical spine are other possible symptoms. Among milder cases, symptoms may be missing or difficult to discern, making it possible for some sufferers to be unaware of their condition.

Diagnosis

A variety of scans are commonly used to diagnosis suspected atlantoaxial subluxation, including x-rays, computed tomography (CT) scans and magnetic resonance imaging (MRI). Upon diagnosis, the physician will determine the best course of treatment for his patient.

Mild Cases

If the condition is not severe, the main goal of treatment will be to provide neck stability to the sufferer. This can be achieved by wearing either a soft or hard cervical collar (neck brace). This orthopedic piece of equipment supports the cervical portion of the spinal cord, preventing it from further injury.

Severe Cases

In more severe cases, hospitalization coupled with enhanced stabilizing techniques is often required. Surgery is the most aggressive step toward treating atlantoaxial subluxation. Spinal fusion (when two or more vertebrae are fused together) may provide greater stability, but often at the detriment to range of motion. More than one surgical procedure may be required to treat the condition.

Prognosis

Those suffering from mild atlantoaxial subluxation may fully recover if the condition is diagnosed early and effectively managed. If atlantoaxial subluxation has led to spinal compression, the prognosis is less favorable. Damage to the spinal cord may not be fixable, although in some cases neurosurgeons are able to restore full or partial function. If the spinal cord cannot be repaired, permanent neurological damage, or even death, may occur.

References

• E-Medicine: Atlantoaxial Instability
• Duke Orthopaedics Presents Wheeless' Textbook of Orthopaedic: Atlantoaxial Subluxation
• Down Syndrome Health: Atlantoaxial Instability in Down's Syndrome
• Hopkins-Arthritis: Rheumatoid Arthritis Symptoms
• The Journal of Bone & Joint Surgery: Spine Fusion for Atlantoaxial Instability