A Morphologically Atypical Case of Atlantoaxial Rotatory Subluxation.
10.3340/jkns.2014.55.5.284
- Author:
Daisuke UMEBAYASHI
1
;
Masahito HARA
;
Yusuke NISHIMURA
;
Toshihiko WAKABAYASHI
Author Information
1. Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan. umebayad@gmail.com
- Publication Type:Case Report
- Keywords:
Atlantoaxial rotatory subluxation;
Atlantooccipital dislocation;
Facet deformity
- MeSH:
Congenital Abnormalities;
Humans;
Meningioma;
Neck;
Occipital Bone;
Songbirds;
Spinal Cord;
Spine
- From:Journal of Korean Neurosurgical Society
2014;55(5):284-288
- CountryRepublic of Korea
- Language:English
-
Abstract:
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.
