C3 and C4 ─ retropharyngeal space should be C2 ─ retropharyngeal space should be Disruption in the smooth curve of the imaginary line connecting the spinolaminar white lines of the vertebral bodies.Neurologic injury occurs from cord compression between the odontoid and posterior arch of C1.Associated fractures of the skull and/or facial bones are common.Anterior atlantoaxial dislocations may be, but are not necessarily, associated with a fracture of the dens (~50% at autopsy).Almost all atlantoaxial dislocations involve forward movement of C1 on C2 posterior dislocation is extremely rare.The pathologic mechanism involves hyperflexion of the neck.Traumatic atlantoaxial subluxation/dislocation usually results from a motor vehicle collision in which an unrestrained occupant’s head strikes the windshield or dashboard.While chronic atlantoaxial dislocations which occur in the above diseases may be severe yet asymptomatic, acute atlantoaxial dislocations are more often symptomatic and can be life-threatening.Other arthridities-such as psoriasis and lupus Morquio syndrome-secondary to odontoid hypoplasia or aplasia Grisel syndrome-atlantoaxial subluxation associated with inflammation of adjacent soft tissues of the neck Rheumatoid arthritis-from laxity of the ligaments and destruction of the articular cartilage Additional pre-surgical re-evaluation with a pre-surgical CT scan and/or MRI scan may be necessary beforehand.Non-traumatic Conditions Associated with Increase inĭown syndrome-due to laxity of the transverse ligament If there is a surgically treatable lesion with significant residual motor weakness after a period of recovery, or if new neurological deterioration is observed, then surgical intervention may be considered. Reassessment at that time may lead to surgery, depending on the underlying cause. In cases where bony arthritis changes are causing the narrowing of the spinal canal and compression of the spinal cord, surgery is usually not performed until the patient has made significant recovery. However, with advanced imaging technology, patients with compression of the spinal cord secondary to traumatic herniated discs and other structurally compressive lesions can be quickly diagnosed and surgically decompressed. Prior to the CT/MRI era, surgical intervention was thought to be more harmful because of the risk of injuring a swollen cervical cord and worsening the patient’s neurological problems. Nonsurgical treatment consists of immobilization of the neck with a rigid cervical collar and rehabilitation with physical and occupational therapy.Īcute surgical intervention is not usually necessary, unless there is significant spinal cord compression. Observed neurological improvement is the most compelling reason not to proceed with surgical treatment in favor of non-surgical management of CCS. These views can help determine whether or not a cervical collar or stabilizing cervical spine surgery is necessary. Flexion/extension plain X-rays can provide a simple means of determining dynamic (movement-related) stability or instability of the spinal column. Both the MRI and CT scan images are static images, meaning they do not evaluate movement. Flexion/extension views (moving the neck forwards and backwards) assist in the evaluation of spinal stability. X-rays of the spine delineate fractures and dislocations, as well as the degree and extent of arthritis type changes. X-ray: Application of radiation to produce a film or picture of a part of the body can show the structure of the vertebrae and the outline of the joints.Combined with MRI scans, it provides a more complete set of information for treatment decision making. It is usually performed prior to MRI scanning. It also shows shape and size of the spinal canal, its contents and the structures around it.
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