Diagnosis and Treatment of Atlantoaxial Instability

  • Jeffrey Scott Fischgrund
  • Jian Yang
Part of the Translational Medicine Research book series (TRAMERE)


Atlantoaxial instability (AAI) is characterized by excessive movement at the junction between the atlas (C1) and the axis (C2), as a result of either a bony or ligamentous abnormality. Early diagnosis and treatment are vital for patients. Clinical symptoms and signs may be different according to the cause, type, site, and specific situation of the atlantoaxial instability. Neurological dysfunction can occur when the spinal cord or adjacent nerve roots are involved. Imaging examinations, especially computed tomography and magnetic resonance imaging (MRI), can provide visual evidence to make a proper diagnosis. Treatments for AAI can be nonsurgical or surgical. The nonsurgical treatments include relative pharmacotherapy and routine immobilization methods. Surgical treatments comprise treatment of primary upper cervical diseases and/or trauma and techniques of C1–C2 fusion (C1–C2 fusion is discussed briefly because it is covered in depth in the following chapter).


  1. 1.
    Blacksin MF, Lee HJ. Frequency and significance of fractures of the upper cervical spine detected by CT in patients with severe neck trauma. AJR Am J Roentgenol. 1995;165(5):1201–4.CrossRefPubMedGoogle Scholar
  2. 2.
    Dickman CA, Greene KA, Sonntag VK. Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery. 1996;38(1):44–50.CrossRefPubMedGoogle Scholar
  3. 3.
    Boden SD. Rheumatoid arthritis of the cervical spine. Surgical decision making based on predictors of paralysis and recovery. Spine (Phila PA 1976). 1994;19(20):2275–80.CrossRefGoogle Scholar
  4. 4.
    Oda T, Panjabi MM, Crisco JJ 3rd. Three-dimensional translational movements of the upper cervical spine. J Spinal Disord. 1991;4(4):411–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Radcliff K, et al. CT and MRI-based diagnosis of craniocervical dislocations: the role of the occipitoatlantal ligament. Clin Orthop Relat Res. 2012;470(6):1602–13.CrossRefPubMedGoogle Scholar
  6. 6.
    Monckeberg JE, et al. CT scan study of atlantoaxial rotatory mobility in asymptomatic adult subjects: a basis for better understanding C1-C2 rotatory fixation and subluxation. Spine (Phila PA 1976). 2009;34(12):1292–5.CrossRefGoogle Scholar
  7. 7.
    Katzberg RW, et al. Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center. Radiology. 1999;213(1):203–12.CrossRefPubMedGoogle Scholar
  8. 8.
    Kurd MF, et al. Magnetic resonance imaging following spine trauma. JBJS Rev. 2015;3:10.Google Scholar
  9. 9.
    Bae YJ, et al. Cervical compressive myelopathy: flow analysis of cerebrospinal fluid using phase-contrast magnetic resonance imaging. Eur Spine J. 2017;26(1):40–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Bydon M, et al. The current role of steroids in acute spinal cord injury. World Neurosurg. 2014;82(5):848–54.CrossRefPubMedGoogle Scholar
  11. 11.
    Nickel VL, et al. The halo. A spinal skeletal traction fixation device. J Bone Joint Surg Am. 1968;50(7):1400–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Lind B, Sihlbom H, Nordwall A. Halo-vest treatment of unstable traumatic cervical spine injuries. Spine (Phila PA 1976). 1988;13(4):425–32.CrossRefGoogle Scholar
  13. 13.
    Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 1974;56(8):1663–74.CrossRefPubMedGoogle Scholar
  14. 14.
    Lee TT, Green BA, Petrin DR. Treatment of stable burst fracture of the atlas (Jefferson fracture) with rigid cervical collar. Spine (Phila PA 1976). 1998;23(18):1963–7.CrossRefGoogle Scholar
  15. 15.
    Guo X, et al. Bilateral atlas laminar hook combined with transarticular screw fixation for an unstable bursting atlantal fracture. Arch Orthop Trauma Surg. 2009;129(9):1203–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Kamal Y, et al. Atlas and axis injuries role of Halovest. Int J Health Sci (Qassim). 2014;8(4):335–45.Google Scholar
  17. 17.
    Dai L, et al. Os odontoideum: etiology, diagnosis, and management. Surg Neurol. 2000;53(2):106–8. discussion 108–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Spierings EL, Braakman R. The management of os odontoideum. Analysis of 37 cases. J Bone Joint Surg (Br). 1982;64(4):422–8.CrossRefGoogle Scholar
  19. 19.
    Klimo P Jr, et al. Os odontoideum: presentation, diagnosis, and treatment in a series of 78 patients. J Neurosurg Spine. 2008;9(4):332–42.CrossRefPubMedGoogle Scholar
  20. 20.
    Grob D, et al. Biomechanical evaluation of four different posterior atlantoaxial fixation techniques. Spine (Phila PA 1976). 1992;17(5):480–90.CrossRefGoogle Scholar
  21. 21.
    Brooks AL, Jenkins EB. Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am. 1978;60(3):279–84.CrossRefPubMedGoogle Scholar
  22. 22.
    Dickman CA, et al. The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg. 1991;74(2):190–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Coyne TJ, et al. C1-C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery. 1995;37(4):688–92. discussion 692–3.CrossRefPubMedGoogle Scholar
  24. 24.
    Holness RO, et al. Posterior stabilization with an interlaminar clamp in cervical injuries: technical note and review of the long term experience with the method. Neurosurgery. 1984;14(3):318–22.CrossRefPubMedGoogle Scholar
  25. 25.
    Jeanneret B, Magerl F. Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord. 1992;5(4):464–75.CrossRefPubMedGoogle Scholar
  26. 26.
    Goel A, Laheri V. Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir. 1994;129(1–2):47–53.CrossRefPubMedGoogle Scholar
  27. 27.
    Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila PA 1976). 2001;26(22):2467–71.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. and Shanghai Jiao Tong University Press 2018

Authors and Affiliations

  • Jeffrey Scott Fischgrund
    • 1
  • Jian Yang
    • 2
  1. 1.Department of Orthopaedic SurgeryWilliam Beaumont HospitalRoyal OakUSA
  2. 2.Department of OrthopedicsQingdao Municipal HospitalQingdaoChina

Personalised recommendations