Craniovertebral Injuries
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Which is the most common injury leading to anterior dislocation of the atlanto-axial segment, a transverse ligament tear or a dens fracture?
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What is the commonest mechanism of trauma in dens fractures, high velocity flexion or high velocity extension?
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Is major neurological involvement common or uncommon in cases of dens fracture?
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List three non-traumatic conditions that could lead to atlanto-axial instability and dislocation.
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In the normal individual what should be the maximum separation between the dens and the anterior arch of atlas in full flexion?
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A dens fracture
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High velocity flexion
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Uncommon, in one study only 8% had major neurological deficit
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Ankylosing spondylitis, rheumatoid arthritis, Grisel's sydnrome, Reiter's disease, pseudogout
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3 millimeter (4 millimeters in rheumatoid arthritic patients) anything over 4 millimeters is considered a candidate for surgery
References:
Skinner, HB. Editor. Current Diagnosis and treatment in Orthopedics. Appleton & Lange Norwalk 1995
Francis WR; Fielding JW; Hawkins RJ; Pepin J; Hensinger R. Traumatic spondylolisthesis of the axis. J Bone Joint Surg [Br , 63-B(3):313-8 1981
Anderson, LD. D'Alonzo, RT. Fractures of the odontoid process of the axis. J Bone Joint Surg (A) 56:1663 1974
Errico, TJ. Editor. Spinal Trauma, Lippincott, Philadelphia 1991.
Disclaimer:
The assessment and treatment techniques depicted or described in this site are not intended to replace formal instruction in orthopedic manual or any other type of physical therapy. They are intended to review, augment and facilitate the knowledge and skills previously gained on manual therapy or other course and to stimulate the untrained or trainee physical therapist to increase the bounds of his or her knowledge and skill base.
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