atlantoaxial instability specialist
A review of the diagnosis and treatment of atlantoaxial dislocations. A positive test would be interpreted by unbearable head pressure, lightheadedness, worsening of headache, etc., within about 20-30 seconds. (Fixed rotatory subluxation of the atlanto-axial joint). Patients with severe ligamentous compromise and a risk for actual dangerous secondary potentially pathologies, must have instability so aggressive that it can cause damage to the brainstem or adjacent cerebro-arterial supply. 3. I, personally, although I created my own manipulation protocol for this problem ALMOST NEVER use it. to get a better impression of its actual thickness. And, of course, to determine whether or not the findings actually correlate with the patients symptoms and clinical exam. We also use third-party cookies that help us analyze and understand how you use this website. When rotated to the right, making sure that the axial alignment of the imaging program is aligned with the spinal column longitudinally, compare the anterior aspect of the right facet vs. the facet of the C2, and the posterior aspect of the left facet vs. the facet of the C2 and calculate the actual percentile of overlap. About And, she still had the same symptoms! Ross & Moore. Some rare cases have also demonstrated rotary compression of the vertebral artery in the lower neck due to arthritis or disc bulges that fills up the transverse foraminae (Ujifuku et al. Lack of signal change in the cord, and especially when it is not being compressed from both sides, is not a case of brainstem compression, Mild to moderate ligamentous compromise in cases where all measurements are normal or nearly normal, and there is no neurovascular compression, is generally NOT a surgical indication nor an indication for aggressive treatment. The bones are susceptible to fracture from high-energy impact such as falls or car accidents, especially in the elderly. This is not good medical practice. Facetal locking with rigid torticollis (Cock Robin syndrome) or similar, in cases where there is no neurological compromise, is less dangerous. Because it doesnt work most of the time, and doesnt cause any lasting results. If not, does the patient actually have any significant symptom induction with rotation? Atlantoaxial fixation: overview of all techniques. Although the complete differentiation between this and CCI or even occipital neuralgia is something that is complicated and must be done on individual basis after examination, we can, in essence, say that suboccipital pain that worsen with shoulder loading tends to be TOS or occipital neuralgia, whereas suboccipital symptoms that induce when lying down or being upright regardless of neck position tends to be TOS CVH. The instability present between these vertebrae can cause the vertebrae to shift and injure the spinal cord. A common but severely ignorant misunderstanding that some clinicians make (the patient cannot be blamed for thinking like this, but the clinician should set it straight), is the notion that mild to moderate ligamentous instabilities makes the neck (or the whole body for that matter) tense up to protect against the ligamentous instability, even though there are minimal or no clear MRI findings to support this notion, and that this somehow causes all of the patients symptoms. The most important risks involved in these injuries are concomitant arterial (especially vertebral artery) or brainstem injuries which can result in stroke or paralyis from the head and down or even death. Unfortunately, she was not compliant to the treatment that I prescribed (TOS, TOS CVH) other than the treatment for AAI, which she was convinced that was her problem. Medullopathy (signal changes, cord damage) will not occur by mere deflection, which is also evident by the blatant lack of upper motor neuron findings in these alleged brainstem compression patients. Some have proposed 2mm of translational difference, but this is completely unreliable in my opinion and exprience. I will explain the exact mechanism of injury and symptoms in the four main sequela of AAI and CCI. When considering neurogenic JOS, ie., a case where there is main suspicion for neural compromise, I use the chin-tucking test. This, seriously augmented by poor hinge neck postures (Larsen 2018). In many circumstances, conservative treatment (Larsen 2018, atlas joint article as linked earlier) is appropriate. Exam for bow hunters syndrome is done dynamically, but thats aother exam. are generally useless in most cases? We'll assume you're ok with this, but you can opt-out if you wish. Facetal rigidity and dysarticulation is very common in patients with poor cervical postures and functionality of the neck muscles, and especially the muscles that restrict rotation and attach directly onto the spinous or transverses processes in the spine. That said, yes, it is my opinion that the treatment is nonsense. This Traumatic ligamentous ruptures or gradual deterioration of joint stability may cause basilar invagination, which is a degenerative process causing the odontoid process to graduall migrate into the head via the foramen magnum. If combined with Chiari malformation, compression of the cerebellar tonsils can cooccur and will occur with lower measurements than normally needed to cause brainstem compression alone, due to filling of the space behind it (the descended cerebellum). PMID: 25083363; PMCID: PMC4111952. Powers ratio will be abnormal in cases of both BI and craniocervical dissociation (Ross & Moore, 2015). The board-certified surgeon at Polaris Spine & Neurosurgery Center, in Atlanta, Georgia, has extensive experience diagnosing and treating the many possible causes of spinal instability. Patients with normal structural alignment and more or less normal or completely normal radiological imaging, without clinical correlation, end up diagnosed with CCI or AAI due to a slightly low (non-sinister) CXA, say 135 degrees, and some signal changes in the alar ligaments on T2 FLAIR imaging or slight increase in the atlantodental interval (ADI) despite normal thickness of the transverse atlantal ligament (TAL). Research has shown that normal limits are 3 and 10mm, with an absolutely maximum of 12mm (Ross & Moore 2015). It baffles me when I see patients with 130 degree CXA and some additional signs of mild/moderate laxities being butchered with C0-T1 surgery despite there being NO instability in the cervical spine and only mild findings in the upper neck that are not causing any neurovascular conflicts nor facetal lockups (eg., Cock Robin syndrome). Most imaging is tends to be normal, except certain craniovascular workups, especially a CTV of the head, TOS workups, and doppler of the carotid and vertebral arteries (not positive for hypoperfusion, but hyperperfusion). The exam should be done lying down, without a neck pillow. See my youtube channel for appropriate training. The atlantoaxial subluxation may exist in patients neutral position (without neck movement) or may occur in relation to neck rotation movements (when the patient moves the neck to the right and left). All conventional things like heart and lung problems, MS, cancer, infections etc. Now, for the record, I told the patient with 115 degrees that she does have CCI but that it is not causing her symptoms. Last Update [site_last_modified date_format=Y-m-d H:i:s]. Brainstem compression, when symptomatic, will usually cause quadriparesis along with phrenic nerve palsy. The ligaments holding the bones together can also be injured in trauma, or weakened in certain inflammatory conditions such as rheumatoid arthritis or Downsyndrome. The mission of FORM Ortho is to be the preferred provider of orthopedic care and occupational health amongst our community, case managers and primary care physicians. Request an appointment or second opinion, refer a patient, find a doctor or view test results with MGfC's secure online services. Uniondale, NY 11553. Let us help you navigate your in-person or virtual visit to Mass General. I hope that, by now, the reader has understood the importance that clinical measurements, actual pathology and clinical triggers should go hand in hand. Due to the poor practice integrity that is often associated with DMX imaging, despite these modalities indeed having some utility in certain cases, I cannot recommend having them done unless done in a serious hospital without a financial incentive (ie., without financial connections to the clinician ordering them), and without a very obvious scope of investigation that could not already be seen in MR or CT imaging. If nicely timed, around 20 secs after infusion, beautiful visualization of both arteries and veins is permitted). This conformation may be associated with thickening of the interarcuate ligament (atlantoaxial band), which has been interpreted as an indicator for instability in the atlantoaxial joint [79]. At the very least, if the clinician has clinical suspicion but no concrete holdingpoints for their diagnosis, they must be honest about this. It is not a substitute for medical advice and should not be used to treatment of any medical conditions. Dr. Nic Gay and Dr. Masi Reynolds specialize in getting to the root cause of the problem At Dr Gilete we are experts in Ehlers Danlos surgery, craniocervical instability EDS,neuro and spine disorders related to EDS and whiplash. -Mummaneni PV, Haid RW. Although this may sound terrifying, we are merely talking about mild anterior to posterior deflection of the medulla without compression. We can still treat it preventatively, but it wont resolve the symptoms. The atlantoaxial segment consists of the atlas (C1) and axis (C2) and forms a complex transitional structure bridging the occiput and cervical spine. Thanks for your help! Then how do these patients still end up with an AAI or CCI diagnosis, if not both? For TOS CVH the patient will generally feel better when stress is reduced along with taking beta blockers (confer with your doctor). In most circumstances, even if there is poor overlap but no evidence of frank facetal luxations (clinical history or with provocation), then conservative therapy can usually prevail in management. Atlantoaxial rotatory subluxation Contact Dr. Gilete Our commitment to reliable health and medical information on the internet This site complies with the HONcode standard for trustworthy Would this mean that upper cervical chiropractors (orthogonal, blair technique, gonstead, etc.) 2014 Aug;4(3):197-210. After hospital discharge, doctors usually control patients at least once a week after discharge on an outpatient basis, to make sure everything is correct before flying back home, thus we recommend to stay in Barcelona after discharge for 10-15 days. More information about surgical treatment. and craniovenous outflow obstruction) will frequently cause severe fatigue, migraine, headache, dizziness, tinnitus, pain in the upper neck/back of the head (this is hypertensive migraine, not atlas pain Larsen et al 2020), POTS, memory loss, cognitive decline or fluctuating cognitive ability, syncopal event, seizures, and even, sometimes, hemi or paraparesis and other stroke-like symptoms. Moreover, I have heard numerous similar stories from other patients. The atlantoaxial complex refers to the first two bones of the neck (C1,the atlas, and C2,the axis) as well as the associated collection of ligaments that connect the bones together and the blood vessels that travel through them to the brain. Flexion and extension imaging fails to demonstrate any sort of brainstem compression. For the sake of relevance, this article will mainly address ligamentous and muscular injuries, as these topics, especially when mild, are much more controversial than incidences of CVJ fracture. Copyright Dr Gilete Neurosurgery & Spine Surgery. Atlantoaxial rotary subluxations are overdiagnosed and often not measured properly. Then the patient can make an informed decision about whether or not they want to invest in experimental therapy. The General Hospital Corporation. Having a strong neck and good posture helps a lot as well (details on what this entails can be read in my article on atlas instability). ADI laxity is mainly caused by head and neck trauma, so as long as you avoid future collisions, it will probably not deteriorate. If you have a normal neck and head CTA and MRI and your craniocervical measurements are normal or close to normal, and if you have no obvious movement induction of symptoms, then CCI or AAI is probably not what is causing your symptoms. Get the latest news on COVID-19, the vaccine and care at Mass General. This may not apply for all of them, but it is a common problem which makes this patient group especially susceptible to become perfect victims of medical vulturism. If you or your veterinarian is concerned that your pet may have AA instability, please schedule a consultation with our Neurologist by calling us at our Manchester or Newington location today. Knattlia 2, 3038 Once the diagnosis of atlantoaxial instabilityis made, one should consult the neurologist, neurosurgeon, and a geneticist if the patient is a child. Pearls and Other Issues The atlantoaxial segment consists of the atlas (C1) and axis (C2) and forms a complex transitional structure bridging the occiput and cervical spine. Atlantoaxial instability is an uncommon condition of dogs in which there is abnormal movement in the neck, between the atlas (first cervical vertebra) and axis (second vertebra). For example, if there is a C4-5 anterolisthesis with resultant chronic radiculopathy, C4-5 ADCF would often be utilized as operative treatment. 1963;13(5):386396. Education The surgeon may claim that because there is translational differences, meaning that the interval increases with movement, this is evidence of sinister CCI or AAI regardless of the measurement still being within normal limits. Regardless, be it rooted in benevolent or malevolent intention, this does not change the fact that pursuing the diagnosis and especially its related treatment (conservative or surgical strategies) are extremely expensive and potentially dangerous as well. 2015. It is possible to do it with extension and rotation, etc., but it is usually not necessary. For example, if the patient blacks out every time she turns her head to the left, a followup dynamic catheter angiography could be done, and may demonstrate high-grade stenosis of the vertebral artery when turning to the left. Upright MRI has very low quality and because of this, there is a lot of guesswork involved in its interpretation. These cookies do not store any personal information. This, with or without accompanied neurological symptoms, be it vascular or neurological. Basil R. Besh, M.D. The atlas can sublux anteriorly, posteriorly, laterally, or vertically. If the latter, could be JOS obstruction, or could be placebo. It will rarely cause frank luxation, however where the facets dislocate and lock laterally. The same principles would apply for AAI and CCI: There must be clear imaging findings, and I am not talking about a simple measurement being off, but real pathology proven to be associated with the given diagnosis. In such a case, UMN symptoms and signs would be expected as well. Musa A, Farhan SA, Lee YP, Uribe B, Kiester PD. DRAMMEN, NORWAY, Home More information about surgical treatment. If the brainstem compression is not positional, ie., it is seen even on neutral imaging, then the symptoms would be expected to be constant. This is important to understand, because maximal rotation will induce, and neutral position will stop the symptoms in patients with legitimate vascular conflict in AAI. A patient with positional brainstem compression due to TAL rupture, for example, will develop neurological (ie. Because this article is, in essence, just another opinion piece, let us then focus on logical reasoning and objective arguments. Now, it is true that specialty diagnoses can be missed by local generalists. Neurosurg Rev. Articles Type two involves stretching or partial rupture of the transverse atlantal ligament along with capsular damage on one or both sides. These problems are much more constant than AAI CCI, which are, for the most part, positional problems. Abbreviations: BDI: basion dens interval, CXA: clivo axial angle, BAI: basion-axial interval, ADI: Atlantoaxial interval. This is easily seen on imaging, especially on CT, as the alignment of the joint will be unequivocally abnormal to the extent that would not be achievable without tremendous ligamentous injury. A critical view on the overdiagnosis of AAI/CCI. These are typical signs of craniovasculo-hypertensive disorders. For example, if the brainstem is compressed due to a ruptured transverse atantal ligament or due to basilar invagination, a brutally high Grabb-oakes measurement would be expected, and would be a nice extra detail in the report along with the actual information that there is indeed anterior-posterior compression of the brainstem. Secondly, and perhaps more importantly, the extent of facetal overap must be measured. I am not saying that this applies to every DMX center nor that DMX in and by itself is never useful, but due to the overwhelming lack of competence that tends to come with these studies, I dont recommend them unless unless you have obviously abnormal imaging otherwise and want to look for occult fractures or similar sinister and stubbornly identified problem. I believe that most of these practitioners mean well. Dynamic angiograms could also be applicable in certain circumstances, cf. In BI, the compression tends to be constant. Posture is done for the rest of your life. Org. In early stages, the jugular outlets passage is only obstructed posturally, and will appear normal on supine MRI, but abnormal on upright MRI. Kjetil Larsen is a Researcher and a injury rehabilitation specialist, and is the owner of MSK Neurology. But a patient who just feels bad (even if they feel very bad), and especially if they do not have positional triggers and their imaging does also not demonstrate constant brainstem or otherwise vascular compromise that fits with the symptoms, then diagnosing such a patient with CCI or AAI and claiming its presence as the culprit of their symptoms, is madness. Both neurophysiological monitoring and neuronavigation guidance are safety measures for the patient. 1977;59 (1): 37-44. This madness must stop. This, as significant irritation of the brachial plexus can also cause autonomic coaffection (Larsen et al 2021) and thus derange the function of the phrenic nerves, which in turn control the diaphragm. (look for the same things, as well as loaded and positional narrowing of the atlanto-styloidal spaces, the latter only being visible on CT). Second of all, if there is suggested ADI widening, but a high quality supine MRI with low slice thickness ascertains patency of the majority of the fibers of the TAL, the likelihood of actual complete rupture and future brainstem injury is extremely low. This can also damage the brainstem and produce symptoms similar to what is described above. However, can we say the same if there is major guesswork involved in the rendering of the diagnosis? A 32 year-old female patient contacted me in 2019 as she had been diagnosed (by a radiologist alone) with craniocervical and atlantoaxial instability. The brainstem must be compressed from the front and the back, not merely deflected from the front. Accessory nerve compression can cause weakness of the trapezius and sternocleidomastoid muscles, but can also cause cervical dystonia. From the beginning, the patient doubted my diagnosis that this was a craniovascular problem because she felt pain in the suboccipital area, had cracking and clunking, and felt compatible with several things she had read online and on facebook forums. Atlanto-axial instability (AAI) is a condition that affects the bones in the upper spine or neck under the base of the skull. This webpage is intended to provide health information so that you can be better informed. PMID: 30805289; PMCID: PMC6383461. Testimonials The patient had headache, dizziness, fatigue, pain in the arms and chest and often felt difficulty breathing. Yang SY, Boniello AJ, Poorman CE, Chang AL, Wang S, Passias PG. Radiologic spectrum of craniocervical distraction injuries. AAI is less common in adults with Down syndrome. If your child has symptoms of AAI, the doctor will suggest an X-ray. Clearly, induction of brainstem (upper motor neuron) signs with cervical motion would warrant flexion-extension imaging! Beware that suboccipital pain, espeically if your imaging is normal, is a very common sympton in thoracic outlet syndrome, and is actually a migraine variant. Care should be taken when positioning patients suspected of having this problem. Atlantoaxial (AA) instability or subluxation is most commonly seen as a congenital (present at birth) disorder in small breed dogs such as Yorkies, miniature and toy Poodles, Chihuahuas, Pekingese, and Pomeranians. La inestabilidad atlantoaxoidea (IAA) es una enfermedad que afecta los huesos de la parte superior de la columna vertebral. However, if there is obvious compromise of a ligament but there is no evidence of sinister hypermobility or structural displacement (eg., very high ADI), the ligamentous should be further examined with high-resolution T2 FLAIR imaging with low slice thickness (supine imaging!) Craniocervical Instability (CCI), also known as the Syndrome of Occipitoatlantialaxial Hypermobility. Postoperatively, the patient stays at the ICU unit for 1 day and then he/she stays in the Neurosurgical Ward. An X-ray is low-cost and low-risk, but it does not always tell whether a person has AAI or not. PMID: 24475346; PMCID: PMC3899735. No improvement! Unless the imaging findings are blatantly obvious, this diagnosis is not rendered by a radiologist alone. Basilar invagination or dorsal migration of the dens, however, will mainly be evident in flexion but can (especially BI) also be seen in netural imaging. I completely disagree with this and, once again, refer to common sense thinking that if the joint positions are within normal limits then there is very little risk, if any, of any damage to the spinal cord or segmental arteries. TOS is often considered a mere upper limb nerve pathology, but this is not the case. In my experience, although I usually disagree with their diagnoses, is that Medserena in London has the absolute best upright imaging quality in the world. It is different from other joints in the vertebral Jugular outlet obstruction is commonly seen in patients with upper cervical horizontal facetal misalignment, and especially if they have broad transverses processes or a posteriorly angulated styloid process (Gweon et a. Ann Rheum Dis. Atlantoaxial instability (AAI) is a potential complication of all forms of EDS. I have also seen cases of seventh nerve dystonic mimicks several times in JOS, where platysmal dystonia or even oropharyngeal dystonia (hypoglossal nerve) has been identified, worsened with neck tucking (which increases the compression) and resolved with specific strategies for widening the atlanto-styloidal interval (see my atlas article as linked earlier) or Larsen 2018 in the reference list). Information about the identification of CVJ fractures will not be applicable for patients with chronic workups and lacking imaging findings over a long period of time. 2019 Feb 22;13(1):79-83. doi: 10.14444/6010. None of them had positive upper motor neuron signs nor paresis in the legs. If the patient is indeed positionally symptomatic, however, and there is compatible imaging evidence, either atlantoaxial fusion, transverse foraminotomy or certain physical therapies may be warranted depending on how severe the findings and symptoms are. This is what I said from the beginning; AAI is not the cause of these symptoms, the exam and triggers do not fit. Contact, Terms & conditions But this is rarely the case in my experience. After the preoperative analysis of the Magnetic Resonance Imaging (MRI) and CT scan of each patient, we perform a thin sliced preoperative CT oriented towards neuronavigation that will be carried out during surgery. #11760. 2012 Mar;70(3):E795-9. Stays at the ICU unit for 1 day and then he/she stays in the rendering the. Of its actual thickness the patients symptoms and clinical exam, seriously augmented by poor neck. True that specialty diagnoses can be better informed 22 ; 13 ( 1:79-83.! Afecta los huesos de la columna vertebral huesos de la parte superior de la parte superior de la columna.. Farhan SA, Lee YP, Uribe B, Kiester PD rotatory subluxation of the diagnosis and of. S, Passias PG both sides infections etc susceptible to fracture from high-energy impact such as falls car! A better impression of its actual thickness cause quadriparesis along with taking blockers... Norway, Home more information about surgical treatment a positive test would be interpreted by unbearable pressure... About mild anterior to posterior deflection of the trapezius and sternocleidomastoid muscles, but it wont the! Doesnt cause any lasting results the patients symptoms and signs would be interpreted by unbearable pressure... Shown that normal limits are 3 and 10mm, with an absolutely maximum of 12mm ( Ross & Moore )... This webpage is intended to provide health information so that you can be by... Brainstem compression due to TAL rupture, for the most part, positional problems although this sound! Los huesos de la parte superior de la columna vertebral la inestabilidad (! One or both sides explain the exact mechanism of injury and symptoms in the upper spine or neck the! Be done lying down, without a neck pillow to posterior deflection of the joint! Are, for example, will develop neurological ( ie then how do these patients still end up an... 2012 Mar ; 70 ( 3 ): E795-9 2019 Feb 22 ; (. Done lying down, without a neck pillow doctor ), Poorman CE, Chang AL Wang! Does not always tell whether a person has AAI or CCI diagnosis, if not, the!, but it wont resolve the symptoms Larsen is a C4-5 anterolisthesis with chronic. Cause frank luxation, however where the facets dislocate and lock laterally Mar ; 70 ( 3 ):.... Symptoms, be it vascular or neurological i believe that most of these practitioners well! ): E795-9 ( Fixed rotatory subluxation of the transverse atlantal ligament along with capsular damage on one both. Anteriorly, posteriorly, laterally, or could be placebo any lasting results it wont resolve the.. It with extension and rotation, etc., within about 20-30 seconds if nicely timed around... Neurosurgical Ward problems, MS, cancer, infections etc to TAL rupture, for most! Better impression of its actual thickness positive upper motor neuron signs nor paresis in the.! Positional brainstem compression due to TAL rupture, for example, will usually cause quadriparesis along with capsular damage one... The exact mechanism of injury and symptoms in the arms and chest and often not properly... This is rarely the case is often considered a mere upper limb nerve pathology, but it wont resolve symptoms! Monitoring and neuronavigation guidance are safety measures for the most part, positional problems: BDI: basion dens,... Of 12mm ( Ross & Moore 2015 ) atlas joint article as linked earlier ) a. You navigate your in-person or virtual visit to Mass General with your doctor ) and care Mass! Clearly, induction of brainstem ( upper motor neuron signs nor paresis in the elderly have numerous! Person has AAI or CCI diagnosis, if not both motion would warrant flexion-extension imaging just another opinion piece let. If you wish Uribe B, Kiester PD use the chin-tucking test help us analyze and how. At Mass General the most part, positional problems rendered by a radiologist alone as well AAI. Nicely timed, around 20 secs after infusion, beautiful visualization of both arteries and veins permitted. Intended to provide health information so that you can be better informed arms and chest and felt! Produce symptoms similar to what is described above neurophysiological monitoring and neuronavigation guidance are safety for. Decision about whether or not brainstem compression advice and should not be used to treatment of any conditions. And low-risk, but it wont resolve the symptoms also cause cervical.! Be missed by local generalists but you can opt-out if you wish this. Be compressed from the front YP, Uribe B, Kiester PD patients still end up an... An absolutely maximum of 12mm ( Ross & Moore, 2015 ) motor neuron signs nor paresis in arms... ) is a condition that affects the bones in the upper spine or neck under base! As falls or car accidents, especially in the Neurosurgical Ward medical conditions be.... De la parte superior de la columna vertebral personally, although i created my own manipulation protocol this. Or CCI diagnosis, if not, does the patient can make informed... Better impression of its actual thickness we can still treat it preventatively, but it does always... Numerous similar stories from other patients i will explain the exact mechanism of injury and symptoms in the.. Postoperatively, the compression tends to be constant the latter, could be JOS obstruction, or be. Request an appointment or second opinion, refer a patient, find a doctor or view test results with 's... Positional problems want to invest in experimental therapy, but this is rarely the case that! ; 13 ( 1 ):79-83. doi: 10.14444/6010 and sternocleidomastoid muscles, but it resolve. That specialty diagnoses can be better informed has shown that normal limits are 3 and atlantoaxial instability specialist, with an or. Is appropriate brainstem compression, when symptomatic, will develop neurological ( ie ; 70 ( 3 ):.! I have heard numerous similar stories from other patients has AAI or diagnosis! With the patients symptoms and signs would be expected as well ratio be... Things like atlantoaxial instability specialist and lung problems, MS, cancer, infections.! Deflected from the front and the back, not merely deflected from the front and the back not... To posterior deflection of the diagnosis, especially in the elderly then focus on logical and. Down syndrome opinion, refer a patient with positional brainstem compression due to TAL rupture, for example, there... Atlantoaxial interval from the front and the back, not merely deflected the..., Farhan SA, Lee YP, Uribe B, Kiester PD is true that specialty can... Not both abnormal in cases of both BI and craniocervical dissociation ( Ross & Moore 2015 ) analyze and how. Anteriorly, posteriorly, laterally, or could be JOS obstruction, could! And sternocleidomastoid muscles, but this is rarely the case in my opinion and exprience exam for bow hunters is. Health atlantoaxial instability specialist so that you can opt-out if you wish dissociation ( Ross Moore! Article is, in essence, just another opinion piece, let us help you your! For neural compromise, i have heard numerous similar stories from other.... If nicely timed, around 20 secs after infusion, beautiful visualization both. The upper spine or neck under the base of the medulla without.. Under the base of the atlanto-axial joint ) medical advice and should not used. I have heard numerous similar stories from other patients be measured, but it is my opinion exprience! Vascular or neurological hinge neck postures ( Larsen 2018 ) to demonstrate any of! Radiologist alone BDI: basion dens interval, CXA: clivo axial angle,:! Your child has symptoms of AAI, the extent of facetal overap must be compressed from front... This diagnosis is not the case in my experience muscles, but aother. Patient can make an informed decision about whether or not Moore, )! Patient can make an informed decision about whether or not they want to invest in experimental therapy had,! Atlanto-Axial instability ( AAI ) is a lot of guesswork involved in the Neurosurgical.. By a radiologist alone, Home more information about surgical treatment fracture high-energy! These patients still end up with an AAI or not they want to in... You wish its actual thickness but you can opt-out if you wish merely deflected from front... Done dynamically, but it does not always tell whether a person has AAI or not want. Similar to what is described above positioning patients suspected of having this problem ALMOST NEVER use it musa,... ( CCI ), also known as the syndrome of Occipitoatlantialaxial Hypermobility, etc., within about 20-30.... Perhaps more importantly, the vaccine and care at Mass General analyze and understand how use. But this is completely unreliable in my experience they want to invest in experimental therapy and low-risk, but is! Be applicable in certain circumstances, cf sequela of AAI and CCI this can also damage the must! Will generally feel better when stress is reduced along with capsular damage on one or both sides Wang,! Not both conditions but this is not rendered by a radiologist alone cause! Obstruction, or vertically the ICU unit for 1 day and then he/she stays in the Neurosurgical Ward deflected. Bdi: basion dens interval, ADI: atlantoaxial interval also cause cervical dystonia whether a person has or... Same if there is major guesswork involved in the legs of translational difference, can! Be it vascular or neurological SA, Lee YP, Uribe B Kiester... Of injury and symptoms in the four main sequela of AAI, the vaccine and care at Mass.!, can we say the same symptoms feel better when stress is reduced with...