Goel Atul, Shah Abhidha, Rajan Sanjay
Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G. S. Medical College, Parel, Mumbai, India.
J Neurosurg Spine. 2009 Jul;11(1):9-14. doi: 10.3171/2009.3.SPINE08927.
The authors' experience with treatment of 8 patients with "vertical mobile and reducible" atlantoaxial dislocation is reviewed. The probable pathogenesis, radiological and clinical features, and management issues in such cases are discussed.
Between January 2006 and March 2008, 8 patients who presented with vertical mobile and reducible atlantoaxial dislocations were treated at the Department of Neurosurgery at King Edward Memorial Hospital in Mumbai, India. The vertical atlantoaxial dislocation/basilar invagination reduced completely on extension of the neck, with no need of any cervical traction. According to the extent of superior migration of the odontoid process, and measurements based on the vertical atlantoaxial instability index, the dislocation was graded as mild, moderate, or severe. All patients were treated using the C-1 lateral mass and C-2 pars plate and screw method of fixation.
The study group was composed of 5 male and 3 female patients (mean age 24 years, age range 8-54 years). All patients presented with the physical features of short neck, torticollis, pain in the nape of the neck, and varying degrees of quadriparesis. In 6 patients there was a history of trauma prior to the onset of major neurological symptoms. The dislocation was mild in 3 cases, moderate in 1, and severe in 4. All patients had clinical neurological improvement following surgery. The follow-up duration ranged from 4 to 30 months (mean 18 months).
Vertical mobile and reducible atlantoaxial dislocation is a discrete clinical entity. Abnormal inclination and incompetence of the facet joint appears to be the primary causative factor that resulted in vertical dislocation or basilar invagination. Posterior fixation in the reduced dislocation position forms the basis of treatment.
回顾作者对8例“垂直可移动性和可复位性”寰枢椎脱位患者的治疗经验。讨论此类病例可能的发病机制、放射学和临床特征以及治疗问题。
2006年1月至2008年3月期间，印度孟买爱德华国王纪念医院神经外科对8例表现为垂直可移动性和可复位性寰枢椎脱位的患者进行了治疗。寰枢椎垂直脱位/基底凹陷在颈部伸展时完全复位，无需任何颈椎牵引。根据齿状突上移程度，并基于垂直寰枢椎不稳定指数进行测量，将脱位分为轻度、中度或重度。所有患者均采用C-1侧块和C-2椎弓根钢板螺钉固定方法进行治疗。
研究组包括5名男性和3名女性患者（平均年龄24岁，年龄范围8 - 54岁）。所有患者均表现出短颈、斜颈、颈后疼痛以及不同程度的四肢瘫的体征。6例患者在出现主要神经症状之前有外伤史。脱位轻度3例，中度1例，重度4例。所有患者术后临床神经功能均有改善。随访时间为4至30个月（平均18个月）。
垂直可移动性和可复位性寰枢椎脱位是一种独特的临床实体。小关节面的异常倾斜和功能不全似乎是导致垂直脱位或基底凹陷的主要致病因素。在复位后的脱位位置进行后路固定是治疗的基础。
