• World Neurosurg · Aug 2024

    Post-traumatic Central or Axial atlantoaxial dislocation (CAAD) presenting with 'atypical' symptoms- Analysing the role of dynamic imaging on the basis of experience with 14 patients treated by atlantoaxial fixation surgery.

    • Atul Goel, Sasha Blaskovich, Abhidha Shah, Apurva Prasad, Ravikiran Vutha, and Ashutosh Shukla.
    • Department of Neurosurgery, Lilavati Hospital and Research Center, Mumbai, India; Department of Neurosurgery, R.N. Cooper Hospital and Medical College, Mumbai, India; Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India; Department of Neurosurgery, K.J. Somaiya Medical College, Hospital and Research Center, Mumbai, India; Department of Neurosurgery, K.E.M Hospital and Seth G.S. Medical College, Mumbai, India. Electronic address: atulgoel62@hotmail.com.
    • World Neurosurg. 2024 Aug 1; 188: e134e144e134-e144.

    BackgroundThis is a report of a series of 14 patients who presented with a range of "atypical" cranial, spinal, and systemic symptoms that started after they suffered a relatively severe injury to the head and/or neck several months or years before surgical treatment. The implications of diagnosing and treating central or axial atlantoaxial dislocation (CAAD) is discussed. Also, the role of dynamic rotatory and lateral head tilt imaging in the diagnosis and treatment is analyzed.MethodsOf the 14 patients, 7 were men and 7 were women, with an age range of 21-64 years (average, 42 years). Due to the severity of the presenting neurological and non-neurological symptoms, all the patients had lost their occupation and were heavily dependent on painkillers and/or antidepressant drugs. In addition to other characteristic clinical and radiological evidence, CAAD was diagnosed made based on the facet alignments on lateral profile imaging in the neutral head position. Dynamic head flexion-extension, lateral head tilt, and neck rotation imaging findings confirmed and subclassified CAAD. All 14 patients underwent atlantoaxial fixation surgery.ResultA personalized self-assessment clinical scoring parameter and the World Health Organization Disability Assessment Schedule 2.0 was used to evaluate the outcome. One patient did not follow-up after surgery. At a minimum follow-up of 6 months after atlantoaxial fixation surgery, the remaining 13 patients experienced relief from all major symptoms.ConclusionsDiagnosing and treating CAAD can have major therapeutic implications for patients presenting with progressively worsening disabling clinical symptoms following relatively severe head and/or neck trauma.Copyright © 2024 Elsevier Inc. All rights reserved.

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