How do you assess atlantoaxial instability?
The ADI is determined by measuring the distance between the posterior edge of the anterior arch of C1 and the anterior edge of the dens. A value less than three mm is considered normal in adults and a value less than 4.5 mm is considered normal in children.
How is AAI diagnosed?
Diagnosis. Most cases of asymptomatic AAI are made through screening X-rays. All children with Down syndrome should be screened for AAI by the age of 3. The diagnosis of symptomatic AAI is usually made either through the neurological exam ( the physical exam that examines how the nerves are working) and/or by X-ray.
How is atlantoaxial subluxation diagnosed?
Atlantoaxial subluxation is usually diagnosed with plain neck x-rays. A neutral and forwarded flexed neck x-ray is best as it can demonstrate misalignment. A special radiographic measurement is used called the ADI (5).
How do you manage atlantoaxial instability?
- Medical Care. There are no pharmacologic interventions for atlantoaxial instability (AAI).
- Surgical Care. The treatment goals for persons with AAI are to protect the spinal cord, stabilize the spinal column, decompress neural tissue, and reduce any deformity.
- Activity.
- Long-Term Monitoring.
What may involve atlantoaxial instability?
These include congenital scoliosis,osteogenesis imperfecta,neurofibromatosis, Morquio syndrome, Larsen syndrome, SED congenita, chondrodysplasia punctata, metatropic dysplasia, and Kniest syndrome.
What is a positive sharp Purser test?
A positive test occurs if there is a sliding movement of the head or a decrease in symptoms (often neuro symptoms; “clunk” may occur). Diagnostic Accuracy: Sensitivity: . 69; Specificity: . 96; -LR: . The Sharp-Purser Test decreases symptoms by increasing the vertebral canal space.
Is atlantoaxial instability painful?
Instability of the upper cervical spine is one example of a serious underlying medical condition that can cause neck pain.
What prevents atlantoaxial instability?
Individuals with AAI are restricted from participation in certain activities that may result in cervical spine injury. These include gymnastics, diving, pentathlon, butterfly stroke, diving starts in swimming, high jump, soccer, and certain warmup exercises.
How common is atlantoaxial subluxation?
Spontaneous atlantoaxial subluxation is a well-recognized complication affecting about 2% of patients with AS, presenting with and without signs of spinal cord compression.
What movement does the atlantoaxial joint allow?
The primary movement of the atlantoaxial joint complex is rotation. In rotation the atlas together with the head, rotate around the dens of axis. This movement allows us to turn our head to look towards the left or towards the right.
What causes instability in the atlantoaxial joint?
The atlantoaxial joint is an important “transitional zone” in the cervical spine. prone to instability by both degenerative and traumatic processes. Pathophysiology adult causes degenerative Down’s syndrome. Rheumatoid Arthritis. Os odontoideum.
How to treat atlantoaxial instability in Down syndrome?
A cervical collar and traction can be tried, but if the patient’s clinical symptoms do not improve, surgical treatment is indicated.A hard cervical collar might be needed after C1-C2 surgical fixation.. In most instances, patients with Down syndrome and atlantoaxial instability do not need emergency surgery.
What kind of imaging is needed for atlantoaxial instability?
The odontoid view may show odontoid anomalies or rotary displacement of the odontoid relative to the atlas (C1) arch. A formal diagnosis of atlantoaxial instability (AAI) requires lateral cervical spine imaging in flexion and extension.
What are symptoms of atlantoaxial instability in the ear?
Unilateral or bilateral tingling and numbness may be present. In many instances, infections of the pharynx, the middle ear, and/or the upper respiratory tract precede symptoms of atlantoaxial instability. Clinical deterioration following any of these conditions justifies a complete evaluation. [ 22, 9, 30]