Cargando…

Post-Traumatic Atlanto-Axial Instability: A Combined Clinical and Radiological Approach for the Diagnosis of Pathological Rotational Movement in the Upper Cervical Spine

Post-traumatic rotational instability at the atlanto-axial (C1-2) joint is difficult to assess, much less quantify, due to the orientation and motion plane of the joint. Prior investigations have demonstrated that a dynamic axial CT scan, during which the patient maximally rotates the head right and...

Descripción completa

Detalles Bibliográficos
Autores principales: Kaale, Bertel Rune, McArthur, Tony J., Barbosa, Maria H., Freeman, Michael D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9964642/
https://www.ncbi.nlm.nih.gov/pubmed/36836004
http://dx.doi.org/10.3390/jcm12041469
_version_ 1784896557720535040
author Kaale, Bertel Rune
McArthur, Tony J.
Barbosa, Maria H.
Freeman, Michael D.
author_facet Kaale, Bertel Rune
McArthur, Tony J.
Barbosa, Maria H.
Freeman, Michael D.
author_sort Kaale, Bertel Rune
collection PubMed
description Post-traumatic rotational instability at the atlanto-axial (C1-2) joint is difficult to assess, much less quantify, due to the orientation and motion plane of the joint. Prior investigations have demonstrated that a dynamic axial CT scan, during which the patient maximally rotates the head right and left, can be used to evaluate and quantify the amount of residual overlap between the inferior articulating facet of C1 and the superior facet of C2, as an index of ligamentous laxity at the joint. We have previously demonstrated that a novel orthopedic test of rotational instability, the atlas-axis rotational test (A-ART), may have utility in identifying patients with imaging evidence of upper cervical ligament injury. In the present investigation, we assessed the correlation between a positive A-ART and a CT scan assessment of the relative quantity of residual C1-2 overlap, as a percent of the superior articulating facet surface area of C2. A retrospective review was conducted of the records of consecutive patients presenting to a physical therapy and rehabilitation clinic, over a 5-year period (2015–20) for chronic head and neck pain after whiplash trauma. The primary inclusion criteria were that the patient had undergone both a clinical evaluation with A-ART and a dynamic axial CT to evaluate for C1-2 residual facet overlap at maximum rotation. The records for a total of 57 patients (44 female/13 male) were identified who fit the selection criteria, and among these, there were 43 with a positive A-ART (i.e., “cases”) and 14 with a negative A-ART (i.e., “controls). The analysis demonstrated that a positive A-ART was highly predictive of decreased residual C1-2 facet overlap: the average overlap area among the cases was approximately one-third that of the control group (on the left, 10.7% versus 29.1%, and 13.6% versus 31.0% on the right). These results suggest that a positive A-ART is a reliable indicator of underlying rotational instability at C1-2 in patients with chronic head and neck symptoms following whiplash trauma.
format Online
Article
Text
id pubmed-9964642
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-99646422023-02-26 Post-Traumatic Atlanto-Axial Instability: A Combined Clinical and Radiological Approach for the Diagnosis of Pathological Rotational Movement in the Upper Cervical Spine Kaale, Bertel Rune McArthur, Tony J. Barbosa, Maria H. Freeman, Michael D. J Clin Med Article Post-traumatic rotational instability at the atlanto-axial (C1-2) joint is difficult to assess, much less quantify, due to the orientation and motion plane of the joint. Prior investigations have demonstrated that a dynamic axial CT scan, during which the patient maximally rotates the head right and left, can be used to evaluate and quantify the amount of residual overlap between the inferior articulating facet of C1 and the superior facet of C2, as an index of ligamentous laxity at the joint. We have previously demonstrated that a novel orthopedic test of rotational instability, the atlas-axis rotational test (A-ART), may have utility in identifying patients with imaging evidence of upper cervical ligament injury. In the present investigation, we assessed the correlation between a positive A-ART and a CT scan assessment of the relative quantity of residual C1-2 overlap, as a percent of the superior articulating facet surface area of C2. A retrospective review was conducted of the records of consecutive patients presenting to a physical therapy and rehabilitation clinic, over a 5-year period (2015–20) for chronic head and neck pain after whiplash trauma. The primary inclusion criteria were that the patient had undergone both a clinical evaluation with A-ART and a dynamic axial CT to evaluate for C1-2 residual facet overlap at maximum rotation. The records for a total of 57 patients (44 female/13 male) were identified who fit the selection criteria, and among these, there were 43 with a positive A-ART (i.e., “cases”) and 14 with a negative A-ART (i.e., “controls). The analysis demonstrated that a positive A-ART was highly predictive of decreased residual C1-2 facet overlap: the average overlap area among the cases was approximately one-third that of the control group (on the left, 10.7% versus 29.1%, and 13.6% versus 31.0% on the right). These results suggest that a positive A-ART is a reliable indicator of underlying rotational instability at C1-2 in patients with chronic head and neck symptoms following whiplash trauma. MDPI 2023-02-12 /pmc/articles/PMC9964642/ /pubmed/36836004 http://dx.doi.org/10.3390/jcm12041469 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kaale, Bertel Rune
McArthur, Tony J.
Barbosa, Maria H.
Freeman, Michael D.
Post-Traumatic Atlanto-Axial Instability: A Combined Clinical and Radiological Approach for the Diagnosis of Pathological Rotational Movement in the Upper Cervical Spine
title Post-Traumatic Atlanto-Axial Instability: A Combined Clinical and Radiological Approach for the Diagnosis of Pathological Rotational Movement in the Upper Cervical Spine
title_full Post-Traumatic Atlanto-Axial Instability: A Combined Clinical and Radiological Approach for the Diagnosis of Pathological Rotational Movement in the Upper Cervical Spine
title_fullStr Post-Traumatic Atlanto-Axial Instability: A Combined Clinical and Radiological Approach for the Diagnosis of Pathological Rotational Movement in the Upper Cervical Spine
title_full_unstemmed Post-Traumatic Atlanto-Axial Instability: A Combined Clinical and Radiological Approach for the Diagnosis of Pathological Rotational Movement in the Upper Cervical Spine
title_short Post-Traumatic Atlanto-Axial Instability: A Combined Clinical and Radiological Approach for the Diagnosis of Pathological Rotational Movement in the Upper Cervical Spine
title_sort post-traumatic atlanto-axial instability: a combined clinical and radiological approach for the diagnosis of pathological rotational movement in the upper cervical spine
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9964642/
https://www.ncbi.nlm.nih.gov/pubmed/36836004
http://dx.doi.org/10.3390/jcm12041469
work_keys_str_mv AT kaalebertelrune posttraumaticatlantoaxialinstabilityacombinedclinicalandradiologicalapproachforthediagnosisofpathologicalrotationalmovementintheuppercervicalspine
AT mcarthurtonyj posttraumaticatlantoaxialinstabilityacombinedclinicalandradiologicalapproachforthediagnosisofpathologicalrotationalmovementintheuppercervicalspine
AT barbosamariah posttraumaticatlantoaxialinstabilityacombinedclinicalandradiologicalapproachforthediagnosisofpathologicalrotationalmovementintheuppercervicalspine
AT freemanmichaeld posttraumaticatlantoaxialinstabilityacombinedclinicalandradiologicalapproachforthediagnosisofpathologicalrotationalmovementintheuppercervicalspine