Atlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization
dc.contributor.author | Henderson, Fraser C. | |
dc.contributor.author | Rosenbaum, Robert | |
dc.contributor.author | Narayanan, Malini | |
dc.contributor.author | Koby, Myles | |
dc.contributor.author | Tuchman, Kelly | |
dc.contributor.author | Rowe, Peter C. | |
dc.contributor.author | Francomano, Clair | |
dc.contributor.department | Medical and Molecular Genetics, School of Medicine | |
dc.date.accessioned | 2025-03-11T11:25:19Z | |
dc.date.available | 2025-03-11T11:25:19Z | |
dc.date.issued | 2021 | |
dc.description.abstract | Atlanto-axial instability (AAI) is common in the connective tissue disorders, such as rheumatoid arthritis, and increasingly recognized in the heritable disorders of Stickler, Loeys-Dietz, Marfan, Morquio, and Ehlers-Danlos (EDS) syndromes, where it typically presents as a rotary subluxation due to incompetence of the alar ligament. This retrospective, IRB-approved study examines 20 subjects with Fielding type 1 rotary subluxation, characterized by anterior subluxation of the facet on one side, with a normal atlanto-dental interval. Subjects diagnosed with a heritable connective tissue disorder, and AAI had failed non-operative treatment and presented with severe headache, neck pain, and characteristic neurological findings. Subjects underwent a modified Goel-Harms posterior C1-C2 screw fixation and fusion without complication. At 15 months, two subjects underwent reoperation following a fall (one) and occipito-atlantal instability (one). Patients reported improvement in the frequency or severity of neck pain (P < 0.001), numbness in the hands and lower extremities (P = 0.001), headaches, pre-syncope, and lightheadedness (all P < 0.01), vertigo and arm weakness (both P = 0.01), and syncope, nausea, joint pain, and exercise tolerance (all P < 0.05). The diagnosis of Fielding type 1 AAI requires directed investigation with dynamic imaging. Alignment and stabilization is associated with improvement of pain, syncopal and near-syncopal episodes, sensorimotor function, and exercise tolerance. | |
dc.eprint.version | Final published version | |
dc.identifier.citation | Henderson FC Sr, Rosenbaum R, Narayanan M, et al. Atlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization. Neurosurg Rev. 2021;44(3):1553-1568. doi:10.1007/s10143-020-01345-9 | |
dc.identifier.uri | https://hdl.handle.net/1805/46303 | |
dc.language.iso | en_US | |
dc.publisher | Springer | |
dc.relation.isversionof | 10.1007/s10143-020-01345-9 | |
dc.relation.journal | Neurosurgical Review | |
dc.rights | Attribution 4.0 International | en |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | |
dc.source | PMC | |
dc.subject | Alar ligament | |
dc.subject | Atlanto-axial | |
dc.subject | C1-C2 fusion | |
dc.subject | Dynamic imaging | |
dc.subject | Rotary subluxation | |
dc.subject | Syncope | |
dc.title | Atlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization | |
dc.type | Article |