Nanavati Super Specialty Hospital, Mumbai, Maharashtra, India.
Spine (Phila Pa 1976). 2018 Dec 1;43(23):E1426-E1428. doi: 10.1097/BRS.0000000000002724.
Case report.
We report a rare case of congenital unilateral rotatory atlanto-occipital subluxation that presented with left C1 neuralgia.
Secondary occipital neuralgia is commonly attributed to pathologies of the atlanto-axial joint and C2/C3 nerve involvement. Our case depicts a model of slow creeping atlanto-occipital subluxation due to a rare left C1 superior articular facet dysplasia with C1 foraminal stenosis presenting as C1 neuralgia. We discuss the eitology and patho-anatomy of this rare undescribed presentation.
A 42-year-old gentleman presented with deteriorating and intractable left occipital headache of 6 months duration. The neck disability index (NDI) was 64%. Cervical MR/computed tomography scan showed a unilateral C1 facet dysmorphism with a left sided C1 foramen bony compression. There was no central canal stenosis.
Posterior left C1 arch excision and decompression of C1 foramina with occipital-cervical fusion relieved C1 neuralgia.
Our case depicts a model of slow creeping deformation due to left C1 superior articular facet dysplasia. An abnormal facet slope allowed the occipital condyle to migrate posteriorly and medially leading to crowding of the left C1 foramen. Although the etiology was congenital, the neck spasm was delayed till fourth decade. A secondary C1 foramen stenosis led to C1 occipital neuralgia that presented as an intractable headache.
病例报告。
我们报告了一例罕见的先天性单侧旋转性寰枢关节半脱位病例，表现为左侧 C1 神经痛。
继发性枕大神经痛通常归因于寰枢关节和 C2/C3 神经受累的病变。我们的病例描述了一种由于罕见的左侧 C1 上关节突发育不良伴 C1 孔狭窄导致的缓慢进展性寰枢关节半脱位的模型，表现为 C1 神经痛。我们讨论了这种罕见未描述表现的病因和病理解剖学。
一位 42 岁的男性患者出现进行性和难治性左侧枕部头痛 6 个月。颈椎残疾指数（NDI）为 64%。颈椎磁共振/计算机断层扫描显示单侧 C1 关节突畸形，左侧 C1 孔有骨性压迫。无椎管狭窄。
后路左侧 C1 弓切除和 C1 孔减压及枕颈融合术缓解了 C1 神经痛。
我们的病例描述了一种由于左侧 C1 上关节突发育不良导致的缓慢进展性变形模型。异常的关节突斜率允许枕骨髁向后和向内迁移，导致左侧 C1 孔拥挤。尽管病因是先天性的，但颈部痉挛直到第四十年才出现。继发性 C1 孔狭窄导致 C1 枕大神经痛，表现为难治性头痛。
5 级。
