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[Atlanto-axial kyphosis].

F Kerschbaumer1, M Rittmeister, W Ewald

  • 1Abteilung für Rheumaorthopädie, J.W. Goethe-Universität, Marienburgstrasse 2, 60528 Frankfurt/M.

Der Orthopade
|January 24, 2002
PubMed
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Atlantoaxial kyphosis (AAK) is a rare craniocervical junction deformity. Surgical treatment depends on reducibility, with staged therapy showing success in rheumatoid arthritis patients.

Area of Science:

  • Orthopedics
  • Neurosurgery
  • Radiology

Background:

  • Atlantoaxial kyphosis (AAK) is a rare sagittal deformity at the occipitoatlantoaxial junction, often a manifestation of ligamentous or bony disorders.
  • Rheumatoid arthritis and trauma are the predominant causes of AAK, impacting the craniocervical junction.
  • AAK is characterized as a subtype of anterior translatory atlantoaxial instability.

Purpose of the Study:

  • To define and describe atlantoaxial kyphosis (AAK).
  • To outline diagnostic criteria for AAK using radiographic measurements.
  • To present treatment strategies for both reducible and irreducible AAK, highlighting outcomes in rheumatoid arthritis patients.

Main Methods:

  • Diagnosis of AAK is established via lateral radiographic views of the upper cervical spine.

Related Experiment Videos

  • Radiographic parameters include McGregor's line and the atlas-plane angle (< -15 degrees) or atlas-axis angle (> 105 degrees).
  • Treatment options encompass posterior atlantoaxial fusion (sublaminar wiring or transarticular screws) for reducible AAK and a staged approach (transoral decompression, anterior plating, posterior wiring) for irreducible AAK.

    • Main Results:

    • The study successfully treated rheumatoid arthritis patients with AAK using a staged surgical therapy.
    • Specific surgical techniques like Brooks wiring and Magerl screw fixation are detailed for reducible AAK.
    • Combined anterior and posterior surgical techniques are described for irreducible AAK.

    Conclusions:

    • Atlantoaxial kyphosis requires specific diagnostic criteria and tailored treatment based on reducibility.
    • Staged surgical intervention, including decompression and fusion, proves effective for irreducible AAK, particularly in rheumatoid arthritis.
    • Understanding the nuances of AAK management is crucial for successful patient outcomes.