Atlanto-axial subluxation is a condition in which a specific joint is incompletely dislocated. The condition is also referred to by the common abbreviation AASL by medical professionals in some cases. The affected joint is usually the one located in the middle of the first and second vertebrae in the neck. The cause of atlanto-axial subluxation is usually an unstable joint structure. Atlanto-axial subluxation may damage the medulla of the back.
What is an atlanto-axial subluxation?
In atlanto-axial subluxation, a specific joint is not completely dislocated. The joint affected by the condition is located in the cervical spine. If the disease remains untreated or is treated too late or inadequately, damage to the medulla of the back may result. For this reason, timely diagnosis of atlantoaxial subluxation is of particular importance. In case of corresponding complaints of the disease, a suitable specialist should be consulted so that adequate treatment can be initiated.
Causes
Basically, different factors are known to cause atlantoaxial subluxation. First, some of the affected patients have a deformity that has existed since birth. In the context of this anomaly, the so-called dens axis is not developed as in healthy persons, but has an incomplete form. The dens axis is the second cervical vertebra. This deformity affects not only some people, but also certain dogs. These are usually dog breeds of small size. Sometimes the retaining ligaments of the corresponding cervical vertebra are defectively formed, so that an atlanto-axial subluxation develops. In some cases, the retaining ligaments are too loose or even slack. This is possible, for example, in connection with Marfan syndrome or Down syndrome. In addition, such complaints are frequently seen in connection with knee dysplasia or the so-called Larsen syndrome. Atlanto-axial subluxation is caused in some patients by a fracture of the dens axis. Bony avulsion of the ligament is also a potential factor in the development of the subluxation. In addition, observations show that atlantoaxial subluxation develops clustered in association with juvenile idiopathic arthritis or polyarthritis with a chronic course.
Symptoms, complaints, and signs
The symptoms and signs of atlantoaxial subluxation depend primarily on how much the medulla of the back has already been damaged by the disease. Numerous sufferers experience pain in the neck area. These intensify when patients flex the neck. In addition, some individuals have paralysis of the extremities, which is referred to in medical terms as tetraparesis. Sometimes the so-called proprioception is also impaired. In some cases, gait is significantly disturbed by atlanto-axial subluxation. In this context, for example, the Wobbler syndrome or ataxias occur. In the context of atlanto-axial subluxation existing from birth, the typical symptoms of the disease usually develop in the first year after delivery. The situation is different in the case of atlanto-axial subluxations resulting from trauma. In such cases, the symptoms of the disease appear peracutely and unexpectedly. In some cases, patients suffer from complete paralysis of the extremities.
Diagnosis and course
In making the diagnosis, the symptoms of atlantoaxial subluxation and their visual presentation play the most important role. Patients with the leading symptoms of the disease are recommended to visit a physician to gain certainty about the signs of the disease and initiate appropriate therapy. During the patient interview, the attending physician tries to find out the causes of the disease. Since atlantoaxial subluxation is congenital in some cases, the physician also takes a family history. He then examines the patient clinically using various examination procedures. First, an X-ray examination is usually used to visualize the individual manifestation of the anomaly of the bone. As a rule, the consequences of traumatic effects are also easily recognizable in this way.In addition, some of the patients with the disease also undergo an MRI examination, which is also an imaging procedure. With the help of this examination, the extent of the impairment of the spinal cord can be estimated.
Complications
In most cases, the complications and discomfort of this disease depend greatly on how much damage has already been done to the back. Most often, however, patients experience severe pain in the neck when they bend or stoop. It is also not uncommon for the patient’s extremities to become paralyzed, causing the patient to suffer from limited mobility. The quality of life is greatly reduced by the disease. In the worst case, this can lead to complete paralysis of all extremities, so that normal locomotion is no longer possible. The affected person is then dependent on walking aids or the help of other people. The treatment or therapy is causal. However, it is not possible to treat the congenital disease completely. If the limitations have been caused by trauma or an accident, therapies can be used to increase the mobility of the joint. Surgical interventions can also be used in this case. However, if the paralysis affects the entire body, in many cases no cure is possible and the affected person must live with the symptoms for the rest of his or her life.
When should you see a doctor?
With this disease, a doctor should always be consulted when the first symptoms already appear. The earlier this disease is diagnosed, the more complications and subsequent damage can be limited by appropriate treatment. As a rule, the disease manifests itself through pain in the back and in the area of the neck. If this pain occurs in the long term and does not disappear on its own, a visit to the doctor is definitely necessary. The gait of the affected person may also be restricted by the disease, resulting in gait problems or restricted movement. If these symptoms occur, a doctor should also be consulted. Furthermore, the disease also leads to disturbances in sensitivity or to complete paralysis of the individual extremities. Even in these extreme cases, a visit to the doctor is necessary. As a rule, the disease can be diagnosed by a general practitioner. Further treatment is then provided by therapists and other specialists. However, a completely positive course of the disease cannot be guaranteed in every case, so patients may have to spend their lives with restrictions.
Treatment and therapy
Treatment of atlantoaxial subluxation is based on the individual patient’s symptoms. When there is only instability, therapeutic intervention is not necessary in numerous cases. The damage to the medulla of the back is usually the determining factor for or against therapy. For example, a surgical intervention in which the joint is stabilized is possible. Patients who have suffered from atlantoaxial subluxation since birth usually have a relatively good prognosis. The symptoms also tend to be mild compared to acquired subluxations. The prognosis is much worse in cases in which the atlanto-axial subluxation developed as a result of traumatic impact and is associated with paralysis of the extremities.
Outlook and prognosis
The prognosis of an atlanto-axial subluxation depends on the time of diagnosis, a possible start of treatment, and the presenting cause. Nevertheless, the overall outlook for freedom from symptoms is considered good. The later therapy can begin, the higher the risk of secondary diseases or permanent impairments. If the cause of existing complaints is localized quickly, the prognosis is good. The not completely dislocated joint is straightened within a few minutes by a few expert grips of an orthopedist or chiropractor. Afterwards, the organism needs some time of healing and calming of the nerve fibers before the patient is considered free of complaints. If treatment options are delayed, damage to the spinal cord can occur. These are usually considered irreversible and must be treated in further therapies. In severe cases, surgical intervention is necessary to restore skeletal system function.If a child is born with an atlantoaxial subluxation, there is also a good chance of a permanent cure. If other symptoms such as paralysis or trauma are present, the prognosis is somewhat less favorable overall. If the symptoms were acquired in an accident, the chances of recovery depend on the overall accidental damage and injuries. There is a possibility of lifelong impairment because individual regions are no longer adequately supplied via the nerves or muscles.
Prevention
Atlantoaxial subluxation can only be prevented in cases where it is not a congenital condition.
Aftercare
There are usually very few measures and options for aftercare available to the affected person with this disease. In this disease, first and foremost, a rapid diagnosis with subsequent treatment is required, as this is the only way to prevent further symptoms and complications. In this case, self-healing cannot occur either, so that treatment must be carried out in any case. The disease does not always have to be treated. The treatment depends on the exact manifestation of the symptoms. However, regular checks and examinations by a doctor should be carried out in order to detect further damage. In severe cases, those affected are not infrequently dependent on physiotherapy measures. Many of the exercises from such therapy can also be performed in the patient’s own home. This speeds up the healing process. The care and support provided by friends or one’s own family can have a positive effect on the further course of the disease and prevent other complaints. The disease also does not have a negative effect on the life expectancy of the person affected. Further measures of aftercare are not necessary in this case.
What you can do yourself
In conservative treatment, the patient receives cortisone-free rheumatic drugs (NSAIDs) for the pain. With massages and physiotherapy, other options are available to compensate for the pain. In addition, these therapies serve to prevent progression of the dislocation and protect the spinal cord. A cervical collar is used to stabilize the damaged joint complex in the neck. Surgical intervention with osteosynthesis measures, in which the joints are stabilized with lag screws, Kirschnern nails and cerclage, has proven to be most effective against the impairment. Especially in the case of a congenital condition, such an intervention can provide significant relief and more freedom of movement. Since bending strains the neck, a grasping forceps can help to master everyday life as painlessly as possible. With the ATLANTOtec atlas correction technique, there is now an alternative, massage-assisted procedure that has provided good results for patients and gives new hope. The developers and users of this procedure believe that a permanent solution to the problem is possible without injections or surgery. A specially developed massage, which is specifically applied to the atlas, is supposed to gradually compensate for the dislocations in the neck area and initiate the healing process. After the dislocation is relieved after a few months, the remaining bone misalignment is to be localized using the latest image resolutions and addressed by a final adjustment.
