Atlantoaxial instability in os odontoideum with myelopathy.

Abstract:

STUDY DESIGN:This study analyzed the correlation between the atlantoaxial instability (especially sagittal plane rotatory instability) and myelopathy. Thirty-four patients with os odontoideum were reviewed in clinical symptoms and radiographs. OBJECTIVES:The results were correlated to provide a rationale for the genesis of myelopathy. SUMMARY OF BACKGROUND DATA:Instability of the atlantoaxial joint has been evaluated with atlantodental interval, space available for the spinal cord, instability index, and others. These are excellent indices for anteroposterior instability. However, they are insufficient for the evaluation of the multidirectional instability in os odontoideum. METHODS:Thirty-four patients were analyzed in three parameters on the lateral radiographs: the minimum distance from the posterior border of the C2 body to the posterior arch of atlas, the difference of the atlanto-axial angle between the flexion and extension position (sagittal plane rotation angle), and the change of space available for the spinal cord from flexion to extension (Instability Index). RESULTS:The correlation between the sagittal plane rotation angle and the instability index was low (r = 0.561). In patients with more than 20 degrees of the sagittal plane rotation angle, myelopathy was shown at a high rate (86%). Myelopathy was also shown at a high rate (90%) in the patients with more than 40% of the instability index. CONCLUSIONS:It is important to check the sagittal plane rotation angle and the instability index to evaluate the instability in os odontoideum. If the patient has either a sagittal plane rotation angle of more than 20 degrees or an instability index of more than 40%, he or she is likely to have the cord signs.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Watanabe M,Toyama Y,Fujimura Y

doi

10.1097/00007632-199606150-00007

subject

Has Abstract

pub_date

1996-06-15 00:00:00

pages

1435-9

issue

12

eissn

0362-2436

issn

1528-1159

journal_volume

21

pub_type

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