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The distances between the dens and surrounding structures are also key features that can suggest the diagnosis, with the normal distance between the dens and basion (i.e., dens–basion interval; BDI) measuring less than 9 mm on CT, and the distance between the atlas and dens (i.e., atlas–dens interval; ADI) measuring less than 3 mm on CT, although this can be increased in cases of ...
Up to 10% of patients with rheumatoid arthritis are at risk of sudden death due to unrecognized cord compression. [2] Thus surgical intervention is a reasonable choice in the presence of a neurologic deficit as a result of instability. In fact, early surgery for atlantoaxial subluxation may actually delay the debilitating progress of myelopathy ...
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 .
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]
Instability of the cervical spine can cause endangerment of patients and their neurological integrity. [28] Correction and decompression cervical spinal surgeries significantly increase quality of life and reduce symptoms. Post-surgery, 93 to 100 percent of patients report reduced cervicocranial syndrome symptoms such as neck pain. [29] [30]
A widening of the atlanto-axial joint, as measured between the posterior surface of the anterior arch of atlas and the front of the odontoid process, indicates an injury to the transverse atlantal ligament. [6] Normally, this atlanto-dental distance is less than 2 mm, sometimes a maximum of 3 mm is accepted in men and 2.5 mm in women. [6]
Excessive laxity of the posterior transverse ligament can lead to atlantoaxial instability, a common complication in patients with Down Syndrome and Ehlers–Danlos syndrome. Laxity has also been hypothesized as the cause of degenerative hypertrophy and mechanical atlantoaxial stress. [ 3 ]
Deformities of the spine, such as scoliosis (curvature of the spine), kyphosis (a thoracic hump), tethered spinal cord syndrome, craniocervical instability (CCI), and atlantoaxial instability may also be present. [48] [49] Osteoporosis and osteopenia are also associated with EDS and symptomatic joint hypermobility [50] [51]