Atlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization

dc.contributor.authorHenderson, Fraser C.
dc.contributor.authorRosenbaum, Robert
dc.contributor.authorNarayanan, Malini
dc.contributor.authorKoby, Myles
dc.contributor.authorTuchman, Kelly
dc.contributor.authorRowe, Peter C.
dc.contributor.authorFrancomano, Clair
dc.contributor.departmentMedical and Molecular Genetics, School of Medicine
dc.date.accessioned2025-03-11T11:25:19Z
dc.date.available2025-03-11T11:25:19Z
dc.date.issued2021
dc.description.abstractAtlanto-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.versionFinal published version
dc.identifier.citationHenderson 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.urihttps://hdl.handle.net/1805/46303
dc.language.isoen_US
dc.publisherSpringer
dc.relation.isversionof10.1007/s10143-020-01345-9
dc.relation.journalNeurosurgical Review
dc.rightsAttribution 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourcePMC
dc.subjectAlar ligament
dc.subjectAtlanto-axial
dc.subjectC1-C2 fusion
dc.subjectDynamic imaging
dc.subjectRotary subluxation
dc.subjectSyncope
dc.titleAtlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization
dc.typeArticle
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