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Atlanto-Axial Subluxation Types

Atlanto-axial subluxation (AAS) is a disorder where there is impaired rotation of the neck caused by fixation of the anterior facet of C1 on the facet of C2. There are several types of subluxations that can occur, including antero-posterior, rotatory, and vertical subluxations. Rotatory subluxations are further classified into four types depending on the degree of rotation and anterior displacement present. Diagnosis involves radiographic imaging to evaluate displacement and range of motion between C1 and C2. Classification is based on the amount of rotation and displacement, with treatments varying depending on classification.

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60 views2 pages

Atlanto-Axial Subluxation Types

Atlanto-axial subluxation (AAS) is a disorder where there is impaired rotation of the neck caused by fixation of the anterior facet of C1 on the facet of C2. There are several types of subluxations that can occur, including antero-posterior, rotatory, and vertical subluxations. Rotatory subluxations are further classified into four types depending on the degree of rotation and anterior displacement present. Diagnosis involves radiographic imaging to evaluate displacement and range of motion between C1 and C2. Classification is based on the amount of rotation and displacement, with treatments varying depending on classification.

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ronny
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© © All Rights Reserved
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Atlanto-axial subluxation

Atlanto-axial subluxation (AAS) is a disorder of C1-C2 causing


impairment in rotation of the neck. The anterior facet of C1 is fixed on
the facet of C2. It may be associated with dislocation of the lateral mass
of C1 on C2.
There are several ways in which a subluxation can occur

antero-posterior subluxation

o
o
o

rotatory subluxation : characterized four different types 3


type I - the atlas is rotated on the odontoid with no
anterior displacement
type II - the atlas is rotated on one lateral articular
process with 3 to 5 mm of anterior displacement
type III - comprises a rotation of the atlas on both lateral
articular processes with anterior displacement greater than 5
mm
type IV - characterised by
rotation and posterior displacement
of the atlas
vertical subluxation

Radiographic features
Plain film (C spine)
In a non traumatic setting flexion and
extension views may be performed. The
expected distance between anterior arch of
C1 and the dens in the fully flexed position should be <3 mm in
an
adult ( ~ 5 mm in a child).
In a vertical subluxation the dens is often above the McGregor line by
over 8 mm in men and 9.7 mm in women

Classification:
- Type I: (most common)
- rotary fixation is w/in the normal ROM and has no anterior
displacement (ie, ADI is normal);
- transverse ligament is intact and odontoid process acts as pivot;
- treated w/ soft collar and analgesics +/- halter traction;
- Type II:
- rotatory fixation w/ anterior displacement of 3 to 5 mm, w/
disruption of the transverse ligament;
- one lateral mass is displaced where as the remaining mass is
intact and acts as a pivot;
- Type III:
- rotatory fixation w/ anterior displacement of more than 5 mm,
which implies disruption of both the transverse and alar ligaments;
- both lateral masses are displaced;
- Type IV:
- rotatory fixation with posterior displacement;

DIAGNOSISa condition in which


there is fixed rotation of C1 on C2;
- fixation may occur with in the range of
normal rotation, may occur w/subluxation,
or may occur w/ dislocation;
- clinically patients will have ipsilateral
rotation and contralateral tilt of the head in
relation to the lateral mass of C1;
- the contra-lateral
sternocleidomastoid may be spastic;
- rotatory fixation may arise from neglected cases of torticollis;
- often, the diagnosis is delayed by several months upto 1 year;
- key feature is that when head is rotated maximally to opposite side, the
malaligned relationship of C1 to C2 appears unchanged;
- pertinent anatomy:
- anatomically, if the patient's head is turned to the right, then the
right lateral mass of C1 is rotated posteriorly;
- if transverse ligament is intact, only a severe amount of rotation can
result in facet dislocation and subsequent narrowing of the SAC;
- if transverse ligament has ruptured, 5 mm of anterolithesis and 45 deg
of rotation will narrow the SAC to less than 12 mm;
- vertebral arteries are also at risk in this situation

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