Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G.S. Medical College, Parel, Mumbai 400012, India.
Acta Neurochir (Wien). 2010 Apr;152(4):709-12. doi: 10.1007/s00701-009-0467-2. Epub 2009 Jul 23.
A case of tuberculosis is reported in which there was extensive unilateral destruction of the bones of the craniovertebral junction. A lateral facetal subluxation of the relatively well-preserved contralateral atlantoaxial joint was identified. The patient was treated with unilateral fixation of the subluxated joint using a lateral mass plate and screw method of fixation. The pathogenesis of facetal subluxation and the rationale of the treatment adopted are discussed.
A 63-year-old male patient had systemic tuberculosis and had been on drug treatment for 5 months. For about 1 month, he had experienced severe neck pain and progressive quadriparesis. Investigations revealed extensive unilateral destruction of the lateral masses of atlas and axis and occipital condyle. MRI showed altered cord signal at the level of the craniovertebral junction. CT scan showed contralateral lateral subluxation of the facet of atlas over the facet of axis. Unilateral fixation and distraction of the lateral mass of atlas and axis, external orthosis and antituberculous drug treatment resulted in rapid and sustained neurological recovery.
Contralateral atlantoaxial facetal subluxation can be a result of osteoligamentous incompetence in cases of tuberculosis where there is unilateral facetal destruction. A coronal CT scan view can be diagnostic in such cases. Atlantoaxial lateral mass fixation can be a rational form of surgical treatment in such cases.
报告 1 例颅颈交界区广泛单侧骨破坏的结核病例。发现相对保存完好的对侧寰枢关节出现侧向关节突半脱位。采用侧块钢板和螺钉固定法对脱位关节进行单侧固定治疗。讨论了关节突半脱位的发病机制和所采用治疗方法的原理。
1 例 63 岁男性患者患有全身结核，已接受药物治疗 5 个月。大约 1 个月前，他出现严重的颈部疼痛和进行性四肢瘫痪。检查发现寰椎和枢椎外侧体部广泛单侧破坏以及枕骨髁。MRI 显示颅颈交界区脊髓信号改变。CT 扫描显示寰椎关节突在枢椎关节突的对侧侧向半脱位。寰枢外侧体部单侧固定和牵开、外固定架和抗结核药物治疗导致快速持续的神经恢复。
在单侧关节突破坏的结核病例中，可能会出现寰枢关节突的对侧侧向半脱位。冠状 CT 扫描可以做出诊断。寰枢侧块固定是此类病例的合理手术治疗方法。
