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. 2013;2013:421087.
doi: 10.1155/2013/421087. Epub 2013 Apr 2.

A Case of Delayed Myelopathy Caused by Atlantoaxial Subluxation Without Fracture

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Free PMC article

A Case of Delayed Myelopathy Caused by Atlantoaxial Subluxation Without Fracture

Ryo Takamatsu et al. Case Rep Orthop. .
Free PMC article

Abstract

We report a case of delayed myelopathy caused by atlantoaxial subluxation without fracture. The patient was a 38-year-old male who became aware of weakness in extremities. The patient had a history of hitting his head severely while diving into a swimming pool at the age of 14 years old. At that time, cervical spine plain X-ray images showed no fracture, and the cervical pain disappeared after use of a collar for several weeks. At his first visit to our department, X-ray images showed an unstable atlantoaxial joint. After surgery, weakness of the extremities gradually improved. At 6 months after surgery, bone union was completed and the symptoms disappeared. This case shows that atlantoaxial ligament injuries are difficult to diagnose and may easily be missed. A high level of suspicion is important in such cases, since neurological compromise or deterioration may occur many years after the injury.

Figures

Figure 1
Figure 1
Plain X-ray images at the first visit under (a) flexion and (b) extension. Instability of the atlantoaxial joint was observed, with ADI increasing to 8 mm under flexion and reducing to ≤3 mm in extension.
Figure 2
Figure 2
CT images after myelography. An increased ADI was apparent without evidence of fracture at the attachment site of the transverse ligament.
Figure 3
Figure 3
Cervical spine MRI. In (a) sagittal and (b) axial T2-weighted images, the high intensity area suggested fluid accumulation between the anterior arch of the atlas and odontoid process of the epistropheus.
Figure 4
Figure 4
Postoperative cervical spine plain X-ray images. Atlantoaxial subluxation was improved with the adhesion of grafted bone.

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