Habitual atlantoaxial subluxation: causes, symptoms, diagnosis, treatment

The most common damage to the upper cervical spine is the habitual atlantoaxial subluxation (ICD-10 code M43.4), which, according to various authors, ranges from 23 to 52% of all spinal injuries. The diagnosis - rotational subluxation of the cervical spine - is exhibited mainly in childhood, revealing asymmetry of the atlantoaxial junction. The triggering mechanism of the appearance of the clinical manifestations of the rotational atlantoaxial subluxation is considered to be the infringement of the capsule of the lateral atlantoaxial joints.

Symptoms of habitual atlantoaxial subluxation

For habitual atlantoaxial subluxation, the head's position, pain and limitation of movements in the cervical spine are characteristic. This condition occurs with minor injuries, for example: after a night's sleep, when turning the head to a shout, with a somersault over the head.

There are several theories explaining the causes of atlantoaxial subluxation - traumatic, inflammatory and dysplastic.

Diagnostics use radiographs of the cervical spine, made in a direct projection - through the open mouth, in the lateral projection - in the middle position of the head and with the head inclined forward and backward. The x-ray triad of the rotational subluxation is characteristic: the asymmetry of the position of the tooth-like process with respect to the lateral masses of the atlas, the different width of the articular joints of the atlantoaxial joints, and the mismatch of their articular surfaces.

There are four groups of rotational atlantoaxial subluxations:

• without anterior displacement of the atlant;
• with the expansion of the Crucelia joint (joint between the posterior surface of the anterior arc of the vertebra C1 and the tooth-shaped process of the vertebra C2) from 3 to 5 mm;
• with the expansion of the Cruevelle joint more than 5 mm;
• rotational subluxation with posterior bias.

With typical clinical and radiologic patterns of rotational atlantoaxial subluxation, involvement of the lower cervical spine can be detected-the formation of angular kyphosis with a vertex at the C3-C4 or C4-C5 level.

Treatment of habitual atlantoaxial subluxation

Conservative treatment of atlantoaxial subluxation is prescribed individually, depending on the clinical manifestations and the data obtained during the survey.

If blocking is detected in the atlantoaxial segment, which is manifested by the forced position of the head, pains and restriction of movements in the cervical spine, - perform manual correction along the Ryshye-Gyuter or skeletal traction. Skeletal traction is carried out using the Glisson loop for 7 days, followed by fixation of the cervical spine in the collar of Shantz for 2-3 weeks. In the future, the patient is taught therapeutic gymnastics, which strengthens the muscles of the neck.

If pain predominates in the clinical picture without signs of blocking in the atlantoaxial segment, the patient is advised to periodically relieve the cervical spine in the collar of Shants for 2-3 weeks, exercise therapy. Physiotherapy treatment - massage and electrophoresis of a solution of trimecaine on the collar area.

Indications for surgical treatment are extremely rare. They are justified with the presence of pronounced neurologic symptoms (as a result of compression of the spinal cord between the posterior surface of the tooth-shaped process and the back surface of the arch at the Atlantic), and also when the Cruevelle joint is expanded by more than 10 mm. The operation is reduced to decompression of the spinal cord and stabilization of the craniovertebral area using metal structures.

[1], [2], [3], [4], [5], [6], [7],