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Atlantoaxial instability is a common asymptomatic finding in rheumatoid arthritis patients. [3] However, it can lead to cervical myelopathy . [ 4 ] Patients with atlantoaxial instability can experience neck pain and headaches in the back of the head (occipital headaches).
Surgery may be used to fix the joint and any associated bone fractures. [1] Neck movement may be reduced long after this injury. [1] Such injuries may also lead to hypermobility, which may be diagnosed with radiographs. [2] This is especially true if traction is used during treatment. [2]
The most common mechanism of injury is high-speed motor vehicle accidents. The injury is more likely in children due to the large size of their heads relative to their bodies, and more horizontal orientation of the occipital condyles. It represents <1% of all cervical spine injuries. [1] Several subtypes of atlanto-occipital dislocation are known.
Craniocervical instability is more common in people with a connective tissue disease, including Ehlers-Danlos syndromes, [1] osteogenesis imperfecta, and rheumatoid arthritis. [2] It is frequently co-morbid with atlanto-axial joint instability, Chiari malformation , [ 3 ] or tethered spinal cord syndrome .
The median atlanto-axial joint is sometimes considered a triple joint: [3] one between the posterior surface of the anterior arch of atlas and the front of the odontoid process; one between the anterior surface of the ligament and the back of the odontoid process; The lateral atlantoaxial joint involves the lateral mass of atlas and axis. [4]
At either lateral extremity, [3]: 426, 430 the membrane is pierced by the vertebral artery [3]: 426, 430, 452 and cervical spinal nerve C1. [3]: 426 The free border of the membrane arches over the artery and nerve, [5] and is sometimes ossified (converting the passage for the vertebral artery into a foramen).
The cruciate ligament of the atlas (cruciform ligament) is a cross-shaped (thus the name) ligament in the neck forming part of the atlanto-axial joint. It consists of the transverse ligament of atlas, a superior longitudinal band, and an inferior longitudinal band. The cruciate ligament of the atlas prevents abnormal movement of the atlanto ...
Notably, joint instability in the neck is a potential complication of rheumatoid arthritis. [15] Participation in sports, being male, variations in the shape of the joint, being older, and joint hypermobility in males are risk factors associated with an increased risk of first time dislocation. [16]