Atlantoaxial joint degeneration radiology Degener-ative changes in the cervical spine have previously been recognized as potentiating injury [6,21,22]. Atlanto-occipital and lateral atlanto-axial joint pain patterns. 4 Early stage atlantoaxial instability Dec 23, 2015 · These joints are primarily responsible for the 0 to 45 degrees of lateral rotation in each direction of the cervical spine. several joints may exhibit degenerative erosions 1: temporomandibular joint. Synovial deposits are most frequent in the wrist, particularly about the radiocarpal and distal radioulnar joints, knee, and metacarpophalangeal and metatarsophalangeal joints. Our experience in the field suggests that atlantoaxial joint instability is an under-recognized and under-treated clinical entity. The terminology can be confusing and the condition is also known as 'atlanto-axial rotatory subluxation' and 'atlanto-axial rotary dislocation'. Oct 22, 2024 · The atlantoaxial joint only refers to half of the craniocervical junction (C1 and C2), omitting the skull's (C0) involvement. Calcified mass behind the dens. 6-year-old male porters carrying loads on the head radiologically presented joint space narrowing with osteophytes, interspinous and transverse ligament calcifications, and occipito-atlantoaxial joint ankylosis, indicating primary OA, but did not all develop AAS or pseudotumor . About 50% of total cervical spine flexion and extension occurs at the occiput–C1 articulation. The pathogenesis of these cysts is often attributed to degenerative changes of the facet joints or microtrauma. 1 CPPD crystal deposition gery, including anterior transoral decompression and posterior fixation, anterior endonasal decompression and fixation, and posterior decompression with AA or occipitocervical fixation, is often the only treatment available. Such pathology cannot be ignored incidentally, but should be recognized as a possible risk factor for significant cervical injury after minor trauma. 001) (Fig. May 29, 2024 · Facet joint degeneration occurs as part of this complex, and as the disc degenerates more load will shift posteriorly and facet joint osteoarthritis will subsequently develop 6. In all six cases, the fracture communicated directly with the subchondral cyst. some osteophytes carry eponymous names: e. symphysis pubis. Keywords: Atlantoaxial dislocation, Classification, Reliability test. Jan 15, 2023 · In this article we provide an overview of the different imaging findings of common joint diseases as a useful tool in daily musculoskeletal radiology. Results: The atlantodens interval narrowed linearly with age (R(2)=0. MRI. Anterior atlantoaxial subluxation is an uncommon cervical spine abnormality but is frequent in the patients with rheumatoid arthritis, with a reported prevalence between 12% and 33%. 2 CT. 1 –3 A diagnosis is made when the ADI, the distance between the posteroinferior aspect of the anterior arch of C1 and the most anterior aspect of the dens, is >3 mm. In Feb 15, 2021 · To report the occurrence of tophaceous gout in the cervical spine and to review the literature on spinal gout. Terminology Antlanto-axial ro Fig. We further conducted a literature review and found a total of 70 other cases of atlantoaxial synovial cysts reported to date in the literature. CT can demonstrate the typical degenerative joint changes seen in osteoarthritis: joint space narrowing, subchondral sclerosis, osteophyte formation, or subchondral cyst formation. CT findings of degenerative arthritis of the atlantoodontoid joint. To identify trauma patients with confirmed tears of the transverse atlantal ligament on cervical MRI and measure several parameters of atlanto-axial alignment on cervical CT, including the anterior atlantodens interval, to determine which method is most sensitive in predicting transverse atlantal ligament injury. To download the citation to this article, select your reference manager software. Jun 10, 2019 · A more recent prevalence study using CT in a group of 1543 adult subjects (aged 18–103 years) found osteoarthritis of the anterior atlantodens joint in 44. 001). Radiographs. , editors. This is attributed to the complex anatomical shape and articulation of the C1 and C2 vertebral bodies. In this evaluation, 717 patients were assessed (Table 1 Acquired anomalies of odontoid may be traumatic, degenerative, inflammatory or neoplastic in nature . Attachments Sep 24, 2024 · Atlanto-axial rotary fixation is a disorder of C1-C2 causing impairment in neck rotation. Nov 20, 2023 · Uncovertebral joints, also called Luschka’s joints, are seen bilaterally between adjacent cervical vertebrae, identified by the cat ear shaped uncinate processes of the C3-7 vertebrae (C1 and C2 have no uncinate processes). 34 High postoperative incidence of degenerative disk disease after fixation for atlantoaxial dislocation has also Oct 27, 2024 · Hacking C, Ismail M, Thibodeau R, et al. Terminology Antlanto-axial ro The formation and growth of NRROPs have been correlated with degenerative alterations of the cervical spine or underlying instability of the atlantoaxial joint, which is responsible for continuous mechanical stress on the ligamentous and cartilaginous complex of the atlantoaxial joint [4,8,12,15,16]. It refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life[1][2]. The atlantooccipital and atlantoaxial joints are the joints at this level responsible for flexion-extension and axial rotation, respectively. 8: Bone marrow edema and joint effusion in the atlantooccipital and lateral atlantoaxial joint seen as high signal on T2W image. , lacking an intervertebral disc, leads to a distinct clinical syndrome resulting from the joint degeneration—unilateral suboccipital pain on the pathological side exacerbated by lateral rotation . The management of the atlanto-occipital and atlanto-axial joint pain. Head and neck blocks. Spinal injections and peripheral nerve blocks: Saunders, USA. Aug 20, 2024 · The atlanto-axial articulation is a complex of three synovial joints, which join the atlas (C1) to the axis (C2). Atlanto-Axial Instability. atlantoaxial dislocation and basilar invagination are indica-tors of degenerative instability of the atlantoaxial joint [27– 30]. 5 mm). The prevalence of LMA in the nonsurgical outpatient setting is 4%. Mar 1, 1990 · The radiological appearances of the atlanto-axial joint are classified in three types, lateral atlanto-axial, atlanto-odontoid and mixed. Atlantoaxial advanced degenerative changes are the main cause of the onset of symptoms (headache), with concomitant reduction in mobility. p. The alar ligaments arise bilaterally from the upper portion of the odontoid process and run obliquely cephalad and laterally to insert on the medial surface of the occipital condyles. Dec 24, 2018 · The unique anatomy of the atlantoaxial articulation, i. The occipitoatlantal joint is the most stable, and the atlantoaxial joint is the most mobile joint of the body. May 29, 2024 · Cervical radiograph demonstrating the atlanto-occipital, atlanto-axial, and cervical facet joints. 1–3 A diagnosis is made when the ADI, the distance between the posteroinferior aspect of the anterior arch of C1 and the most anterior aspect of the dens, is >3 mm. Atlantoaxial osteoarthritis (AAOA) is a degenerative condition that affects the joint between the atlas (C1) and axis (C2) vertebrae in the neck. 08-3%) of the population 2-5. In: Huntoon MA, Honorio B, Narouse S, et al. In AARF, the atlas (C1) is either rotated about the odontoid process or the C1 lateral mass on one side is anteriorly subluxed and rotated relative to the relatively fixed C1-2 facets on the opposite side. Atlantodental interval. The atlantoaxial joint is different from the functional units of the lower cervical spine in that the joint is not a true facet joint because it lacks posterior articulations characteristic of a true zygapophyseal joint. Results: Five (25. In PsA radiography and CT usually visualise new bone formation in Object The authors retrospectively analyzed a series of 108 patients in whom was diagnosed atlantoaxial instability due to degenerative osteoarthritis of the atlantoaxial joints. The presence of cystic degeneration at the atlantoaxial jo … Mar 22, 2018 · Abstract Degenerative changes in the spine have high medical and socioeconomic significance. 00 Jan 12, 2024 · The cruciate ligament of the atlas (also known as the cruciform ligament) is an important ligamentous complex that holds the posterior dens of C2 in articulation at the median atlantoaxial joint. sacroiliac joints. 19), but the pathogenesis and thereby imaging findings are different. Apr 1, 2022 · There is no intervertebral disc between the atlas and the axis; it is connected by the atlanto-odontoid joint and the lateral mass joints on both sides, and it is mainly the transverse atlas ligament that provides joint stability and cervical rotation of 25°–30°. Aug 8, 2019 · Pannus formation in the atlanto-axial joint is a well-recognized complication of rheumatoid arthritis (RA). 30 and Betsch et al. Star denotes atlanto-axial joint. In the retrospective phase, instrumental imaging evaluation of the atlantoaxial joint was performed in all patients with clinical suspicion of involvement. Nov 1, 1997 · Each lateral atlantoaxial joint was considered severely degenerated when advanced narrowing or obliteration of the joint space, subchondral sclerosis, and/or osteophytosis were present. Feb 27, 2014 · 1. will also be diminished in the setting of osteoporosis. 1 Such deposits may mimic idiopathic synovial chondromatosis. 8% of the patients. Waldman MD, JD, in Atlas of Interventional Pain Management (Fourth Edition), 2015 Abstract. The lesion mildly compressed the right hypoglossal canal (Figure 1 Mar 24, 2019 · consequence of pannus formation in the atlanto-axial joint (13). The excess mobility at the articulation can lead to AAI. Methods. They stabilize the head Jun 1, 2010 · A reduction in the height of the atlantoaxial lateral mass complex (100%), mobile atlantoaxial dislocation (100%), basilar invagination (68%), and periodontoid degenerative tissue mass (90%) were AAOA refers to degenerative arthrosis of the lateral (facet) or central atlantoaxial joints, afflicting the facet joint in 12%, atlanto-odontoid articulation in 17%, and both in 71%. The purpose of this study is to characterize imaging findings of Feb 27, 2016 · Degenerative disc disease spondylosis deformans apophyseal joint involvement spinal stenosis foraminal stenosis: Erosive osteoarthritis (affects middle-aged females) Hands: PIP and DIP joint involvement joint ankylosis ‘gull-wing’ deformities (central erosions and marginal osteophytes) Rheumatoid arthritis (F>M Rh factor positive) Hand and Atlanto-axial rotatory fixation (AARF) is a rare condition which occurs more commonly in children than in adults. The cervical changes may include atlanto-axial instability as seen in RA (Fig. 5 Oct 13, 2022 · Joint or pressure erosion may be present in RA, CPPD, gout, and tenosynovial giant cell tumor. Research indicates that osteoarthritis of the atlanto-axial joint affects approximately 44. Imaging. An atlanto-axial subluxation greater than 9mm with vertical settling and a posterior atlanto-odontoid interval less than 14mm are thought to correlate well with the presence of neurologic deficits. Methods One hundred eight patients with osteoarthritis of the atlantoaxial joints and resultant craniovertebral instability—diagnosed on the basis of presenting Jul 4, 2024 · common degenerative joint disease finding. MATERIALS AND METHODS: Twenty-eight healthy volunteers were examined using MRI during maximal head rotation. Direct handling or Sep 29, 2014 · The degeneration of the joints was quantified using a scoring system described by Lakshmanan et al. Signal characteristics vary by etiology. References: Department of Radiology, Diakonhjemmet Hospital, Norway, 2018. CPPD) or an autoimmune process (less likely as erosions are not a predominant feature) causes. 1 Owing to the greater range of motion of the joint and the lack of The atlantoaxial joint facilitates flexion and extension as well as axial rotational movements of the head. Lateral atlanto-axial joints. Nov 23, 2012 · We aimed to establish normal values on MDCT images for the atlantoaxial relationships including the atlantoaxial interval and lateral atlantodens interval (ADI) that could be used to detect atlantoaxial ligamentous injuries in adults and children. Degeneration of the atlantodens and atlanto-axial facet joints at age intervals was quantified. The identification of a periodontoid ligamentous degenerative mass suggests the presence of instability of the atlantoaxial joint. Department of Radiology, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, TX 78236. I wish to update this subject, particularly as regards the clinical implications of facet joint degeneration. Feb 1, 2015 · Our findings show that with age, a significant increase occurs in the prevalence of degenerative changes at the atlanto-axial joint, from 1. Dreyfuss P, Michaelsen M, Fletcher D. The atlanto-axial joint allows 10-15 o of flexion/extension, 30 o of axial rotation and only minimal lateral flexion. Nov 1, 2019 · Objective. • Atlantoaxial interval defined as distance from posterior cortex of the anterior arch of the atlas to the anterior cortex of the dens. Gross anatomy Articu Sep 30, 2023 · T-2 weighted sagittal images of three dogs affected by an atlanto-axial subluxation in this study (TE, 120 ms; TR, 3800 ms; slice thickness, 2. 4% in the sixth decade, increasing to 18. Given the atlantoaxial joint is the most mobile articulation of the spine, it is particularly prone to develop Jun 20, 2000 · AIMS: To measure the range of rotation and determine the instantaneous axis of rotation of the atlanto-axial joint in healthy volunteers using magnetic resonance imaging (MRI) and to highlight the appearances of the rotated atlanto-axial joint on computed tomography (CT) and MRI. 2% by the ninth decade. Each case involved unique presentations and management approaches. Feb 1, 2015 · The anterior atlantodens joint interval was measured. Meniscus-like synovial fold in the atlantoaxial (C1-C2) joint. 4 Early stage atlantoaxial instability usually The atlantoaxial interval is the distance be-tween the lateral mass of C1 and C2 and was mea-sured in the mid-coronal plane of the atlantoaxial joints. 6% of adults, demonstrating a clear correlation with increasing age. 97, p<. In Atlanto axial dislocation by 안광민; C2 cases by Nicholas Willmore; Viva Spine 2021 by Zishan Haider; MSK cases by Asad ur Rehman; C Spine ED by Miguel; SPINE by Gaurav Gupta; Diagnostic Imaging III-Spinal Trauma by Sandra Norton; FRCR 2B 2 by Sherif Mohsen Shalaby; Tony Chen September 2 by Tony Chen; Dr Taha FRCR 2B by Taha Fouad; 27 feb by Jul 16, 2020 · Synovial/Capsular Calcification: Calcification within the synovial membrane is a common feature of CPPD crystal deposition disease. (Level of evidence 5, Level of evidence 1B) Atlanto-axial level is the most frequent cervical spine location of RA with possible life-threating complications. 69). Initial May 29, 2024 · Joint effusions and accumulation of fluid around tendons and within bursae are also common 2. MR imaging is more valuable for determination of hypertrophic changes on the atlantodental joint and grading of the subtype of this disorder. This report details the occurrence of a large and clinically significant finding of tophaceous gout in the atlantoaxial joint of the cervical spine in an 82-year-old Caucasian man with a 40-year history of crystal-proven gout and a 3-month history of new-onset progressive myelopathy. This report raises the question of whether degenerative processes at the C1-C2 articulation predispose elderly patients to injury at this level. e. Black arrows depict the atlanto-occipital joint line. J Spinal Disord 1992; 5 (2): 227-31. Moreover, this case series underscores an important point in regard to the presence of cystic degeneration at the atlantoaxial joint on imaging studies. Degenerative alteration in the occipitoatlantal joint is uncommon, and it is probably related to the strength of the joint and to the limited range of movements. All patients improved postsurgery. The normal range of motion for rotation at the joint is 40 degrees. An open mouth view showed degenerative osteoarthritis of the right atlantoaxial joint with left lateral listhesis of C1 on C2. Click for larger Oct 28, 2024 · Spine Degenerative Cervical Conditions The atlantoaxial joint is an important "transitional zone" in the cervical spine. Jul 1, 2023 · Reduction of the facet joint height can lead to settling of the atlantoaxial complex and is the key factor leading to degenerative AAI. The pivot joint classification means that it allows for rotation only and is formed by a central pivoting, bony structure that rotates around Jun 20, 2000 · AIMS: To measure the range of rotation and determine the instantaneous axis of rotation of the atlanto-axial joint in healthy volunteers using magnetic resonance imaging (MRI) and to highlight the appearances of the rotated atlanto-axial joint on computed tomography (CT) and MRI. The most common cause of AAOA is joint degeneration, which is closely related to age and occupation. Therefore, reconstructing the intervertebral height and sagittal alignment of the atlantoaxial complex is recommended. Arthritis is a challenging topic. We found a significant correlation between age and osteoarthritis for both left and right atlanto-axial facet joints (right atlanto-axial joint: R 2 =0. Thinning and fibrillation of the articular cartilage with associated facet cortical sclerosis and irregularity also occur as in any other degenerating facet joint. The MR features were correlated with clinical and biochemical variables. A long list of diagnoses has to be considered when looking at X rays of the hand and feet, each with its own extensive set of findings. Patients with atlanto-axial arthritis may suffer from suboccipital pain that is exacerbated Oct 12, 2023 · Atlanto-occipital assimilation is the fusion of the atlas (C1) to the occiput and is one of the transitional vertebrae. 1 The paired facet joints and the intervertebral disc form a three joint stabilizing unit at each intervertebral level with disc or facet joint degeneration most often occurring in conjunction with each other but also occurring independently. AAOA is initially managed with conservative treatment. Heberden nodes, Bouchard nodes. CAS PubMed Google Scholar Narouze S. 0%) of the 20 patients exhibited enhancement of the periodontoid synovial spaces after gadolinium administration due to inflammatory synovitis. The joint is reinforced by fibrous capsules which support each joint. The terminology can be confusing and the condition is also known as ‘atlanto-axial rotatory subluxation’ and ‘atlanto-axial rotary dislocation’. Narrowing and erosive changes at the facet joints. The atlanta facets are tilted medially. As acute onsite management of trauma patients continues to improve, CCJ injuries, which often lead to death onsite where the injury occurred, are increasingly being encountered in the emergency department. The anterior facet of C1 is fixed on the facet of C2. Spine 1994; 19 (10): 1125-31. Background multilevel cervical spine disc and facet joint degeneration including C4-7 disc ankylosis and C3-4 canal stenosis due to combination of disc-osteophyte complex and ligamentum flavum hypertrophy. Retrospective, cross-sectional. May 22, 2014 · The atlantoaxial joint allows complex movements of the cervical spine while providing sufficient mechanical strength to stabilize the head. Degenerative facet joint arthropathy can rarely occur without disc degeneration and specific causes (e. Case presentation This paper includes four Iranian male patients and one Iranian female patient with ages ranging from 25 to 46 years old. Risk factors include age … Synovial cysts of the cervical spine causing myelopathy are rare. org (Accessed on 27 Dec 2024) https://doi. It is thoug Degenerative changes in the cervical spine have previously been recognized to potentiate injury. May 23, 2023 · Alar ligament calcification is rare. The Partners HealthCare Research Patient Data Registry was free-text In this cohort, atlanto-occipital joint changes were noted in eight patients and lateral atlanto-axial joint degeneration was also noted in eight patients; however, twenty patients demonstrated atlanto-dens degeneration, and all twenty-three patients had diffuse degeneration of the facet joints in the subaxial cervical spine. We measured the atlantoaxial interval on coronal reformatted images for both the left and right joint spaces. Halswirbelsäule: Diagnostik und Thera-pie. 3—Severe: ankylosis of the joint with excrescences either in the joint or Sep 24, 2024 · Atlanto-axial rotary fixation is a disorder of C1-C2 causing impairment in neck rotation. A line was drawn extending from the inferior articular surface of the lateral cysts at the atlantoaxial joint. Whilst this joint is most mobile, it is also most prone to develop instability. Jul 1, 2019 · Anatomic Considerations for Injection of the Lateral Atlanto-Axial Joint - 24 Hours access EUR €38. May 1, 2010 · Anterior atlantoaxial subluxation is an uncommon cervical spine abnormality but is frequent in the patients with rheumatoid arthritis, with a reported prevalence between 12% and 33%. This joint resides in the upper part of the neck between the first and second cervical vertebrae, also known as the atlas and axis, respectively. Sep 24, 2024 · Atlanto-axial rotary fixation is a disorder of C1-C2 causing impairment in neck rotation. No patient had evidence of rheumatoid arthritis or previous trauma. Joint dysfunction and/or cord compression are present in AAD. In general, there are no reliable imaging features that distinguish rheumatoid arthritis-related pannus from non-rheumatoid retro-odontoid pseudotumor. Apr 1, 2022 · The evidence for therapeutic facet joint interventions is level II-1 for medial branch blocks and level II-1 or II-2 for radiofrequency neurotomy. Pain Physician. 001; left atlanto-axial joint: R 2 =0. B. g. Here, we report the case histories of 3 patients with severely damaged and subluxated Painful atlantoaxial (C1-2) osteoarthritis (AAOA) has been described over 40 years ago. Aug 25, 2019 · Atlantoaxial rotatory fixation (AARF) is also called atlantoaxial rotatory subluxation or fixed atlantoaxial rotatory subluxation . The median atlantoaxial joint is formed by the odontoid process of the axis (C2) and the anterior arch of the atlas (C1). The incidence of lateral atlanto-axial osteoarthritis in the elderly population varies from 4% to 18% . Atlanto-axial subluxation: considered one of the commonest manifestations and may be seen in up to 33% of patients [4]. The radiologic prevalence of advanced degenerative changes at the lateral atlantoaxial Gross well-defined erosion of the dens and atlanto-axial joints typical of rheumatoid arthritis. 3, 4, 5 suggested distracting the C1-C2 lateral facet joints and restoring the height of the lateral atlantoaxial Sep 19, 2022 · Backgroundand Objectives: To date, imaging characterization of non-rheumatic retro-odontoid pseudotumors (NRROPs) has been lacking; therefore, NRROPs have been confused with atlantoaxial joint involvement of rheumatoid arthritis (RA). 24 reported the outcomes of patients with idiopathic degenerative and posttraumatic atlantoaxial osteoarthritis who were treated with upper cervical manipulation in combination with Stability and mobility are hallmarks of the craniovertebral junction. [1]The atlantoaxial segment consists of the atlas (C1) and axis (C2) and forms a complex transitional structure bridging the occiput and cervical spine. Chronic inflammation at the C1/C2 joint may lead to the progressive destruction of bones and ligaments causing subluxations , with further cervical spine compression and even sudden death . Asymptomatic radiographic lateral AAOA has a reported prevalence of 5. The dens rotates within a ring space created by the anterior arch of the atlas and the transverse ligament, and this movement must be accompanied by sliding motion of the facet joints [2]. Nov 12, 2015 · The atlantoaxial joint is the most mobile portion of the spine, predominantly relying on the ligamentous framework for stability at that level. The Jun 1, 2023 · The craniocervical junction is a transitional zone between the cranium and the spine composed of osseous, ligamentous, and muscular structures. Osteoarthritis can be divided into primary and secondary types, but the division is artificial: The underlying cause is evident in secondary osteoarthritis but not in primary or idiopathic osteoarthritis. 6% and that with age, a significant increase occurs in the prevalence of degenerative changes at the atlantoaxial joint, ranging from 1. 4% in the youngest group to 92. While it seems clear that upper cervical stabilizing ligamentous elements against lateral motion (such as the alar ligaments ) are crucial for normal function, little is known about lateral stability assessment in Nov 12, 2015 · The atlantoaxial joint is the most mobile portion of the spine, predominantly relying on the ligamentous framework for stability at that level. The condition may cause severe pain symptoms and disability related to the unilateral suboccipital pain and, in some cases, occipital neuralgia. org/10. It lies behind a large synovial bursa (surrounded by loose fibrous capsule) and consists of two bands: longitudinal band May 29, 2024 · Facet joint degeneration occurs as part of this complex, and as the disc degenerates more load will shift posteriorly and facet joint osteoarthritis will subsequently develop 6. The pathogenesis of this degenerative process represents a biomechanically related continuum of alterations, which can be identified with different imaging modalities. Sep 13, 2023 · The atlantoaxial joint is the bi-axial pivot joint between the atlas (C1) and axis (C2) cervical vertebral bodies that allows for a wide range of mobility at the cranio-cervical junction. 5% (range 0. Thin circumferential fluid within the epidural from C1 to C3 (best seen on STIR images). (A) This dog with atlantoaxial subluxation has intramedullary T2 hyperintensity at the level of compression that likely indicates edema or ischemia (red arrow). Terminology Antlanto-axial ro Oct 13, 2022 · Joint or pressure erosion may be present in RA, CPPD, gout, and tenosynovial giant cell tumor. This is why CCI and AAI are often discussed interchangeably. Lateral atlantoaxial osteoarthritis (AAOA), or C1-C2 lateral mass arthritis (LMA), is an unfamiliar degenerative cervical disease with a clinical presentation that markedly differs from subaxial spondylosis. Itseffects ontheaxialskeleton, including the histology, pathophysiology, andradiographic manifestations, arewellknown [1]. We sought to further characterize these patients. (b) Open mouth radiograph demonstrating occiput, the ring of the atlas, and the body of the axis. Malik et al. Aug 28, 2023 · The atlantoaxial joint is a type of synovial joint that is classified as a uniaxial pivot joint. 3. Chiari malformation is absent. Atlantoaxial fusion is an option fo … Mar 21, 2021 · There is limited information regarding clinical evaluation, imaging assessment, and treatment of lateral atlantoaxial instability. Epidemiology Atlanto-occipital assimilation occurs in approximately 0. T1: usually low. Feb 9, 2017 · Osteoarthritis (degenerative joint disease) is a form of joint disease characterized by degenerative changes involving synovial joints. The presence of abnormal ossifications in the vicinity of the atlantoaxial joint or around the odontoid process can be indicators of instability. Feb 1, 2015 · The atlantodens and atlanto-axial facet joints are anatomically unique and functionally important diarthrodial joints of human spine [1]. subchondral cysts According to a study by Matsunaga et al, a small number of patients (13%) with atlantoaxial dislocation developed postoperative kyphosis and swan neck deformity and more patients (32%) experienced subaxial subluxation after surgery. Apr 18, 2024 · An understanding of the complex anatomy of the craniocervical junction is crucial for recognizing and addressing the inflammatory, degenerative, and tumoral conditions that affect it, enabling improved diagnosis and treatment strategies for atlantoaxial injuries. Stuttgart, New York: Thieme 1999. One of the greatest challenges with AAOA is making the diagnosis. We report here the results of a retrospective analysis of 105 patients with pannus in the atlanto-axial joint. However, the presence of osteoarthritic changes in imaging studies does not mean that the joint is necessarily painful; also the absence of abnormal findings does not preclude the joint from being painful. Feb 22, 2020 · Plain radiographs can assess the atlanto-axial joints (AAJ ) using the open-mouth view but have limited use in visualizing the occipito-atlantal joint (OAJ ). The coronal reconstructed CT image more clearly depicts the joint space narrowing, the subchondral sclerosis, the peripheral osteophyte formation and the erosions of the right atlantoaxial joint. Gross anatomy Articulations paired lateral atlanto-axial joints: classified as planar-type synovial joint between the lateral mas A. specific rotational activities such as golf) should be Jan 1, 2014 · The pathology of lateral atlantoaxial joint pain is usually either degenerative and osteoarthritic or posttraumatic in nature [5, 6]. Terminology Antlanto-axial ro Aug 20, 2024 · The atlanto-axial articulation is a complex of three synovial joints, which join the atlas (C1) to the axis (C2). • In childen, >~5mm widening considered abnormal. Attachments Facet arthropathy is present in 50 percent of the population by age 30 and virtually all over age 60. Dvorak J, Grob D. Atlantoaxial dislocation (AAD) is an anatomical abnormality of the atlantoaxial joint caused by trauma, degeneration, tumors, congenital malformation, pharyngeal inflammation, and surgery. Rotatory fixation is the preferred term, however, as in most cases the fixation occurs within the normal range of rotation of the . Atlantoaxial instability can originate from congenital conditions, but in adults, it is primarily seen in the setting of acute trauma or degenerative changes due to the inflammatory response of rheumatoid arthritis (RA). It may be associated with dislocation of the lateral mass of C1 on C2. 23 Yu et al. AAOA is a clinically common but often overlooked syndrome characterized by persistent occipitocervical pain. Rotatory fixation is the preferred term, … Oct 11, 2024 · Background This case series presents five cases of adult atlantoaxial rotatory subluxation (AARS) following traumatic events, focusing on treatment strategies and long-term outcomes. 00 GBP £33. Introduction. Unfortunately, the authors did not include our several publications on the subject in their reference list [2-8]. We recommend anatomic reduction as an optimal strategy for DAAS. [ 20 ] of Atlantoaxial Rotary Subluxation 697 CT was used to examine six patients with clinically evident atlantoaxial rotary fixation, two patients with torticollis, and six normal subjects who had turned their heads to the side as far as voluntarily possible. The prevalence of intraosseous Early-onset CD can lead to cord complications at a young age and at higher levels of the cervical spine and at the cervicovertebral junction. the-orized that degenerative changes in the subaxial spine pre-disposed the atlantoaxial joint to Furthermore, mean 32. Jul 10, 2000 · Atlanto-axial rotatory fixation (AARF) is a rare condition which occurs more commonly in children than in adults. The cysts caused ventral cervicomedullary compression, did not enhance on magnetic resonance imaging, and were not associated with widening of the anterior atlantodental interval or osseous degeneration of the dens. Results: Atlantoaxial osteoarthritis was found in 4. acromioclavicular joint. [ 19 ] Atlantoaxial (AA) instability is frequent radiological finding in patients with rheumatoid arthritis (RA). However, there have only been 2 reports of C1–C2 facet spacer use in treating AAS. 46–57. There were no signal changes in The degeneration at the craniovertebral junction is manifested by reduced atlantoaxial joint space that results in superior and posterior migration of the odontoid process resulting in generally subtle, but sometimes-severe basilar invagination and relatively “fixed” or only subtly mobile atlantoaxial dislocation. It is important to differentiate these two disease because the treatment strategies may differ. joint erosions. Jun 12, 2023 · The atlantoaxial joint is the most mobile joint, with several critical neurovascular structures traversing through it. The CT appearances of the atlantoaxial complex were identical in all three groups. (a) Oval outlining the atlanto-occipital joint line. This condition involves varying degrees of vertebral body slippage relative to adjacent vertebrae, often caused by ligamentous injury and jumped facets, increasing the risk of spinal cord injury. The aim of this study was to determine the prevalence and radiographic features of After non-diagnostic plain film imaging, CT scan demonstrated unilateral osteoarthritis of the atlantooccipital and atlantoaxial joint in both patients who subsequently underwent posterior O–C2 fusion with resolution of their preoperative symptoms. The purpose of the study was to assess the sagittal spinal canal diameter according to Steel's rule of third and its rela … Feb 1, 2021 · Magnetic resonance imaging (MRI) brain was normal, but the spinal MRI showed degenerative changes at multiple levels in the upper cervical spine with stenosis at the craniovertebral junction (CVJ) and rotatory malalignment at C1-C2 vertebral bodies of left side (Figure 1, case 1) with compression of the C2 root. AAI is more likely to cause [2]: The dens or odontoid process (a small part of the atlantoaxial joint) to move backward towards the brainstem; Brainstem Abstract Study Design. 3, 4 Flexibility is provided by the dens (odontoid process) of C2 (the axis), which articulates with the C1 (atlas) and transverse ligaments, accounting for Nov 8, 2022 · Purpose Kashin–Beck disease (KBD) is an endemic osteoarthropathy affecting the epiphyseal growth plate of multiple joints in young and adolescent patients. 992, p<. The flat and round atlantoaxial joint that allows movements in all directions also makes it susceptible to develop instability. Reference article, Radiopaedia. specific rotational activities such as golf) should be May 11, 2019 · Ogoke BA. The authors report a synovial cyst at the C1-C2 junction in a patient with atlantoaxial subluxation without a congenital a … Sep 6, 2024 · The cystic lesion extended from the level of the atlanto-occipital joint to the level of the atlanto-axial joint. Pannus formation in the atlanto-axial joint is a well-recognized complication of rheumatoid arthritis (RA). The MR imaging appearance of amyloid infiltration within or around the joint consists of extensive deposition of an abnormal soft tissue that usually have the following signal characteristics 2: T1: low signal intensity Apr 20, 2024 · Continuing Education Activity. Occasionally, atlanto-axial pannus is reported when patients without a history of RA undergo magnetic resonance imaging (MRI) of the cervical spine. Dec 3, 2008 · Moreover, this case series underscores an important point in regard to the presence of cystic degeneration at the atlantoaxial joint on imaging studies. Aug 20, 2024 · The atlanto-axial articulation is a complex of three synovial joints, which join the atlas (C1) to the axis (C2). Objectives. Jan 12, 2024 · Each joint is comprised of two concave articular surfaces on the superior aspect of the lateral mass of atlas which articulate with a convex surface on the occipital condyle. MRI examinations were performed on a 1. Atlanto-axial instability (AAI) arises from the compromise of stabilising structures, including the transverse ligament or underlying bony abnormalities It may be possible as well that degenerative affection of the atlantoaxial joint may be the primary event in the development of subaxial spinal degeneration. D … MR imaging of the atlantoaxial joint was performed in all patients within 3 months from diagnosis. 6). flexion Aug 25, 2019 · The earliest findings in degeneration of the lateral atlantoaxial joints is superficial flaking of the articular cartilage. 9% in the oldest group. [1,2] Atlanto-axial dislocation (AAD) and basilar invagination (BI) may be seen in both congenital and acquired conditions. Gross anatomy Articulations paired lateral atlanto-axial joints: classified as planar-type synovial joint between the lateral mas Nov 12, 2015 · The atlantoaxial joint is the most mobile portion of the spine, predominantly relying on the ligamentous framework for stability at that level. 31 as follows: grade 1: normal or narrowed joint space with or without Sep 3, 2023 · DAAS differs from other types of AAS and presents with anterior subluxation combined with vertical subluxation arising from degenerative changes in the atlantoaxial joints. The presence or absence of intraosseous cysts and calcific synovitis was recorded. 1, 3, 4, 5 Goel et al. The condition is characterized by degeneration of the articular cartilage and the formation of osteophytes, or bony growths, within the joint. It is composed of two articulations: the median atlantoaxial joint and the lateral atlantoaxial joint. Degenerative change at the atlantoaxial articulation with loss of joint space at the atlanto-dens articulation and soft tissue calcification; consideration should be given to depositional disease (e. The functional result of the joint is two-fold: (1) providing support for the occiput and (2) providing the greatest range of Feb 1, 2015 · None of the differences between the two sides were statistically significant (p=. Atlantoaxial Osteoarthritis is a metabolically active, dynamic process that involves all joint tissues such as cartilage, synovium/capsule, ligaments and muscles. T2: variable, often heterogeneous Atlantoaxial Block Technique. Indeed, surgical fusion of the C1/C2 junction has been shown to result in regression of pannus tissue on repeat imaging (14-16). It leads to reduced range of movement. Previous studies have focused on the visible deformed extremities instead of the spinal radiological features, especially the atlantoaxial joint. We attempt to analyze available data and evaluate anterior v … Jan 12, 2024 · Each joint is comprised of two concave articular surfaces on the superior aspect of the lateral mass of atlas which articulate with a convex surface on the occipital condyle. There are a number of congenital anomalies which can affect the atlas, axis and the joint between the two: Degenerative arthritis (osteoarthritis) isthemostcommon jointdisease. Imaging of the degenerative spine is a frequent challenge in radiology. T2: variable, often heterogeneous Grading of severity of degenerative changes in the atlanto-occipital, atlanto-dental and lateral atlanto-axial joints. The aim of this article is to review radiological findings Atlantoaxial synovial cysts are rare and the optimal surgical approach has not been determined. At the atlanto-occipital joint level, the lesion was located in the ventral region of the vertebra and was observed to be bilateral, situated around the atlas. CT cervical spine coronal view: erosive changes at the apophyseal joints of C1-C2 with subluxation of the atlantoaxial joint, disc narrowing and erosive changes at the C2-C3 level, extensive disc space narrowing at all levels. The management issues in such cases are discussed. Comprehensive management by a multidisciplinary team is crucial to prevent complications early. Cervical subluxation is the most unstable form of cervical spine injury. 53347/rID-40483 The article is focused on observations of facet joint degeneration and its relationship with degenerative cervical myelopathy. In the presence of atlantoaxial joint arthropathy, pain is usually exacerbated by May 11, 2022 · The joint most frequently subject to degenerative changes in the craniocervical junction is the atlanto-odontoid. 2000;3(3):289–93. 2012. Peak age distribution occurs between 50 and 69 years It is also important that atlantoaxial joint osteoarthritis should be considered in the differential diagnosis in elderly patients examined for neck pain with or without progressive quadriparesis. In the presence of other evidence, instability of the atlantoaxial joint can be expected even when there is no other corroborative radiological evidence. Mostly no serious neurological disorders are expected in such patients. 1 These joints can become a source of axial cervical pain in the event of cervical trauma or as a result of degenerative joint disease. Jan 8, 2011 · Axial PsA may be clinically silent , and involvement of the cervical spine is frequent (atlanto-axial or apophyseal joint changes). 88, p=. However, theradiographic findings of degenerative arthritis intheatlantoodontoid onmedianatlan-toaxialjointhavebeendescribed onlybriefly[1-3],even On CT, osseous abnormalities of the atlantoaxial joint are better visualized than on plain radiographs. Based on these findings, OA is common with 1 day ago · Anterior atlantoaxial dislocations may be, but are not necessarily, associated with a fracture of the dens (~50% at autopsy) Associated fractures of the skull and/or facial bones are common; This injury is unstable; Neurologic injury occurs from cord compression between the odontoid and posterior arch of C1; Imaging findings Nov 17, 2023 · Descriptive characteristics and incidence of severe atlantoaxial joint involvement in our cohort in the retrospective phase of the study. Atlantoaxial instability Imaging findings: • In adults, widening of the atlantoaxial interval >2 mm. From the case: Pannus at the cranio-cervical junction: CT and MRI findings mri Grading the severity of degenerative changes in the anterior atlantodens and lateral atlanto-axial joints 1—None-mild: normal or narrowed joint space with or without minor osteophyte formation. Steven D. 2—Moderate: obliterated joint spacewith or without osteophyte formation.
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