Habitual atlantoaxial subluxation: causes, symptoms, diagnosis, treatment

The most common injury to the upper cervical spine is habitual atlantoaxial subluxation (ICD-10 code M43.4), which, according to various authors, accounts for 23 to 52% of all spinal injuries. The diagnosis of rotational subluxation of the cervical spine is made mainly in childhood, revealing asymmetry of the atlantoaxial articulation. The trigger for the clinical manifestations of rotational atlantoaxial subluxation is considered to be infringement of the capsule of the lateral atlantoaxial joints.

Symptoms of habitual atlantoaxial subluxation

Habitual atlantoaxial subluxation is characterized by a forced position of the head, pain and limited movement in the cervical spine. This condition occurs with minor trauma, for example: after a night's sleep, when turning the head in response to a shout, when somersaulting over the head.

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

In diagnostics, X-rays of the cervical spine are used, performed in a direct projection - through an open mouth, in a lateral projection - in the middle position of the head and with head tilted forward and backward. The X-ray triad of rotational subluxation is characteristic: asymmetry of the position of the odontoid process in relation to the lateral masses of the atlas, different widths of the joint spaces of the atlantoaxial joints and misalignment of their articular surfaces.

There are four groups of rotational atlantoaxial subluxations:

• without anterior displacement of the atlas;
• with widening of the Cruveilhier joint (the joint between the posterior surface of the anterior arch of the C1 vertebra and the odontoid process of the C2 vertebra) from 3 to 5 mm;
• with expansion of the Cruveilhier joint more than 5 mm;
• rotational subluxation with posterior displacement.

In typical clinical and radiographic pictures of rotational atlantoaxial subluxation, involvement of the lower cervical spine may be revealed - the formation of an angular kyphosis with an apex at the level of C3-C4 or C4-C5.

Treatment of habitual atlantoaxial subluxation

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

If blockage is detected in the atlantoaxial segment, which is manifested by a forced position of the head, pain and limited movement in the cervical spine, manual reduction according to Ruchier-Güter or skeletal traction is performed. Skeletal traction is performed using a Glisson loop for 7 days, followed by fixation of the cervical spine in a Shantz collar for 2-3 weeks. The patient is then taught therapeutic exercises to strengthen the neck muscles.

If the clinical picture is dominated by pain without signs of blocking in the atlantoaxial segment, the patient is recommended periodic unloading of the cervical spine in a Shantz collar for 2-3 weeks, exercise therapy. Physiotherapeutic treatment - massage and electrophoresis of trimecaine solution on the collar area.

Indications for surgical treatment are extremely rare. They are justified in the presence of pronounced neurological symptoms (as a result of spinal cord compression between the posterior surface of the odontoid process and the posterior surface of the atlas arch), as well as in the expansion of the Cruveilhier joint by more than 10 mm. The operation is reduced to decompression of the spinal cord and stabilization of the craniovertebral region using metal structures.

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