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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 .
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).
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 ...
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]
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 ]
Spinal manipulation is an intervention performed on synovial joints of the spine, including the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse and costovertebral joints. It is typically applied with therapeutic intent, most commonly for the treatment of low back pain. [1]
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]