title: A review of the diagnosis and treatment of atlantoaxial dislocations.
abstract: Study Design Literature review. Objective Atlantoaxial dislocation (AAD) is a rare and potentially fatal disturbance to the normal occipital-cervical anatomy that affects some populations disproportionately, which may cause permanent neurologic deficits or sagittal deformity if not treated in a timely and appropriate manner. Currently, there is a lack of consensus among surgeons on the best approach to diagnose, characterize, and treat this condition. The objective of this review is to provide a comprehensive review of the literature to identify timely and effective diagnostic techniques and treatment modalities of AAD. Methods This review examined all articles published concerning "atlantoaxial dislocation" or "atlantoaxial subluxation" on the PubMed database. We included 112 articles published between 1966 and 2014. Results Results of these studies are summarized primarily as defining AAD, the normal anatomy, etiology of dislocation, clinical presentation, diagnostic techniques, classification, and recommendations for timely treatment modalities. Conclusions The Wang Classification System provides a practical means to diagnose and treat AAD. However, future research is required to identify the most salient intervention component or combination of components that lead to the best outcomes.
authors.affiliation: Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York, New York, United States.
authors.forename: Sun Y
authors.initials: SY
authors.lastname: Yang
authors.affiliation: Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York, New York, United States.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Boniello
authors.affiliation: Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York, New York, United States.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Poorman
authors.affiliation: Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York, New York, United States.
authors.forename: Andy L
authors.initials: AL
authors.lastname: Chang
authors.affiliation: Orthopaedic Department, Peking University Third Hospital, Beijing, China.
authors.forename: Shenglin
authors.initials: S
authors.lastname: Wang
authors.affiliation: Division of Spinal Surgery, Department of Orthopaedic Surgery, NYU Medical Center Hospital for Joint Diseases, NYU School of Medicine, New York, New York, United States.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
keywords: atlantoaxial dislocation; atlantoaxial subluxation; classification; comprehensive review; diagnosis; treatment
references.citation: Neurosurgery. 2005 May;56(5):1045-50; discussion 1045-50
references.pmid: 15854253
references.citation: J Orthop Res. 1988;6(3):452-61
references.pmid: 3357093
references.citation: Neurosurgery. 2007 Nov;61(5 Suppl 2):311-5; discussion 315-6
references.pmid: 18091245
references.citation: Spine J. 2005 Mar-Apr;5(2):123-9
references.pmid: 15749611
references.citation: Spine J. 2013 Nov;13(11):1455-63
references.pmid: 23850256
references.citation: J Bone Joint Surg Am. 1993 Sep;75(9):1282-97
references.pmid: 8408150
references.citation: J Am Acad Orthop Surg. 2011 Feb;19(2):63-71
references.pmid: 21292929
references.citation: Neurosurgery. 2001 Jul;49(1):71-4
references.pmid: 11440462
references.citation: J Neurosurg. 2003 Jul;99(1 Suppl):80-3
references.pmid: 12859065
references.citation: Pediatrics. 1987 Oct;80(4):555-60
references.pmid: 2958770
references.citation: J Spinal Disord Tech. 2009 Dec;22(8):578-85
references.pmid: 19956032
references.citation: Int J Spine Surg. 2013 Dec 01;7:e20-3
references.pmid: 25694899
references.citation: Neurol India. 2002 Dec;50(4):386-97
references.pmid: 12577085
references.citation: Brain. 1968;91(4):655-84
references.pmid: 5704829
references.citation: Eur Spine J. 2009 Jun;18 Suppl 1:2-6
references.pmid: 19387696
references.citation: Joint Bone Spine. 2002 Mar;69(2):141-54
references.pmid: 12027304
references.citation: World Neurosurg. 2011 Mar-Apr;75(3-4):540-6
references.pmid: 21600509
references.citation: Can J Surg. 2002 Oct;45(5):341-4
references.pmid: 12387536
references.citation: Zhonghua Wai Ke Za Zhi. 2008 May 1;46(9):657-60
references.pmid: 18956715
references.citation: J Neurosurg. 1999 Oct;91(2 Suppl):139-43
references.pmid: 10505495
references.citation: Spine (Phila Pa 1976). 1981 Sep-Oct;6(5):437-40
references.pmid: 6458099
references.citation: J Pediatr Orthop. 2013 Jun;33(4):389-92
references.pmid: 23653027
references.citation: J Neurosurg. 2006 Feb;104(2 Suppl):115-22
references.pmid: 16506499
references.citation: Am J Med Genet C Semin Med Genet. 2006 Aug 15;142C(3):141-8
references.pmid: 16838307
references.citation: Instr Course Lect. 2009;58:717-28
references.pmid: 19385580
references.citation: Neurosurgery. 2005 Jul;57(1 Suppl):E213; discussion E213
references.pmid: 15987596
references.citation: Mod Rheumatol. 2010 Jun;20(3):273-9
references.pmid: 20169388
references.citation: Spine J. 2013 Dec;13(12):1864-71
references.pmid: 24183463
references.citation: J Neurosurg Spine. 2011 Jun;14(6):697-709
references.pmid: 21395398
references.citation: Acta Neurochir (Wien). 2002 Mar;144(3):219-25; discussion 225
references.pmid: 11956934
references.citation: Spine (Phila Pa 1976). 2012 Sep 15;37(20):1742-6
references.pmid: 22472805
references.citation: J Spinal Disord Tech. 2013 Feb;26(1):15-21
references.pmid: 21959834
references.citation: J Neurosurg Spine. 2011 Dec;15(6):678-85
references.pmid: 21854130
references.citation: J Bone Joint Surg Am. 1976 Apr;58(3):400-7
references.pmid: 1262375
references.citation: Spine (Phila Pa 1976). 2008 Mar 15;33(6):624-30
references.pmid: 18344856
references.citation: Spine J. 2013 Nov;13(11):1477-84
references.pmid: 23830828
references.citation: J Bone Joint Surg Am. 1977 Jan;59(1):37-44
references.pmid: 833172
references.citation: Arthritis Rheum. 2000 Nov;43(11):2397-401
references.pmid: 11083260
references.citation: Am J Roentgenol Radium Ther Nucl Med. 1966 Jul;97(3):630-8
references.pmid: 4224599
references.citation: Spine (Phila Pa 1976). 2001 Jan 15;26(2):161-5
references.pmid: 11154536
references.citation: Bull NYU Hosp Jt Dis. 2011;69(2):136-48
references.pmid: 22035393
references.citation: J Neurosurg Anesthesiol. 2009 Jul;21(3):196-201
references.pmid: 19542995
references.citation: Spine (Phila Pa 1976). 2007 Mar 15;32(6):643-6
references.pmid: 17413468
references.citation: J Assoc Physicians India. 2010 Mar;58:187-9
references.pmid: 20848819
references.citation: Spine (Phila Pa 1976). 2006 May 15;31(11):E306-13
references.pmid: 16688020
references.citation: Acta Paediatr Jpn. 1991 Oct;33(5):633-8
references.pmid: 1799117
references.citation: Acta Neurochir (Wien). 1994;129(1-2):47-53
references.pmid: 7998495
references.citation: Orthop Surg. 2010 May;2(2):149-55
references.pmid: 22009930
references.citation: Neurosurgery. 2010 Mar;66(3 Suppl):22-31
references.pmid: 20173524
references.citation: Spine (Phila Pa 1976). 2010 Nov 15;35(24):E1367-72
references.pmid: 21030894
references.citation: J Trauma. 2009 Jun;66(6):1605-9
references.pmid: 19509621
references.citation: Spine (Phila Pa 1976). 2012 Dec 15;37(26):2136-44
references.pmid: 22895480
references.citation: Aust N Z J Surg. 1978 Oct;48(5):570-4
references.pmid: 285707
references.citation: Neurol India. 1999 Sep;47(3):188-95
references.pmid: 10514577
references.citation: Eur Spine J. 2014 Jul;23(7):1442-8
references.pmid: 24395005
references.citation: Spine (Phila Pa 1976). 2008 Mar 15;33(6):620-3
references.pmid: 18344855
references.citation: Acta Neurochir (Wien). 1992;118(3-4):112-6
references.pmid: 1456094
references.citation: Spine (Phila Pa 1976). 2010 Feb 15;35(4):E128-33
references.pmid: 20110836
references.citation: Spine (Phila Pa 1976). 1995 Jun 1;20(11):1233-40
references.pmid: 7660230
references.citation: Ann Emerg Med. 2001 Jul;38(1):1-7
references.pmid: 11423803
references.citation: Spine J. 2007 Nov-Dec;7(6):682-8
references.pmid: 17434809
references.citation: Brain. 1967 Jun;90(2):449-72
references.pmid: 5339110
references.citation: J Rheumatol. 2000 Jan;27(1):90-3
references.pmid: 10648023
references.citation: Spine (Phila Pa 1976). 1983 Jan-Feb;8(1):1-15
references.pmid: 6867846
references.citation: Neurosurgery. 2001 Jul;49(1):65-8; discussion 69-70
references.pmid: 11440461
references.citation: Spine (Phila Pa 1976). 2005 Jul 1;30(13):E375-81
references.pmid: 15990655
references.citation: Pediatr Emerg Care. 2008 Dec;24(12):852-6
references.pmid: 19092567
references.citation: J Neurosurg Spine. 2008 Sep;9(3):296-300
references.pmid: 18928228
references.citation: Neurosurgery. 2006 Mar;58(3):516-21; discussion 516-21
references.pmid: 16528192
references.citation: Neurosurg Clin N Am. 2007 Jul;18(3):499-514
references.pmid: 17678751
references.citation: Spine (Phila Pa 1976). 2012 Apr 1;37(7):E451-5
references.pmid: 21971128
references.citation: J Neurosurg. 1980 Oct;53(4):444-55
references.pmid: 7420164
references.citation: J Neurosurg. 1996 Apr;84(4):573-83
references.pmid: 8613848
references.citation: J Neurosurg Spine. 2005 Jan;2(1):23-6
references.pmid: 15658122
references.citation: J Spinal Disord Tech. 2004 Apr;17(2):158-62
references.pmid: 15260101
references.citation: J Bone Joint Surg Am. 1981 Mar;63(3):342-50
references.pmid: 7204429
references.citation: Spine (Phila Pa 1976). 2013 Oct 1;38(21):E1348-56
references.pmid: 23823573
references.citation: Spine (Phila Pa 1976). 2010 Mar 1;35(5):544-51
references.pmid: 20190626
references.citation: Acta Neurochir (Wien). 2002 Nov;144(11):1165-77
references.pmid: 12434173
references.citation: Spine (Phila Pa 1976). 2001 Nov 15;26(22):2467-71
references.pmid: 11707712
references.citation: Pediatrics. 1984 Jul;74(1):152-4
references.pmid: 6234506
references.citation: Spine J. 2013 Jul;13(7):775-85
references.pmid: 23684237
references.citation: J Neurosurg. 1992 Oct;77(4):525-30
references.pmid: 1527609
references.citation: J Neurosurg. 1991 Jan;74(1):1-7
references.pmid: 1984487
references.citation: Neurosurgery. 2010 Mar;66(3 Suppl):184-92
references.pmid: 20173521
references.citation: Clin Pediatr (Phila). 2013 Jul;52(7):633-8
references.pmid: 23564301
references.citation: Spine (Phila Pa 1976). 2006 Nov 15;31(24):2767-71
references.pmid: 17108826
references.citation: J Bone Joint Surg Am. 1978 Apr;60(3):279-84
references.pmid: 348703
references.citation: Spine (Phila Pa 1976). 2004 Nov 1;29(21):E488-91
references.pmid: 15507788
references.citation: J Bone Joint Surg Br. 1991 Sep;73(5):851-8
references.pmid: 1910048
references.citation: Spine J. 2003 Nov-Dec;3(6):489-95
references.pmid: 14609694
references.citation: JAMA. 1968 Aug 5;205(6):464-5
references.pmid: 4232523
references.citation: J Am Acad Orthop Surg. 2005 Nov;13(7):463-74
references.pmid: 16272271
references.citation: Childs Nerv Syst. 1998 Dec;14(12):719-21
references.pmid: 9881625
references.citation: Injury. 2012 Jul;43(7):1212-5
references.pmid: 22306935
references.citation: Neurosurgery. 2006 Jul;59(1 Suppl 1):ONS84-8; discussion ONS84-8
references.pmid: 16888557
references.citation: Spine (Phila Pa 1976). 2004 Jan 15;29(2):175-81
references.pmid: 14722411
references.citation: J Pediatr Orthop B. 2013 Sep;22(5):404-8
references.pmid: 23764756
references.citation: Neurosurg Clin N Am. 2007 Jul;18(3):463-78
references.pmid: 17678749
references.citation: Arthritis Rheum. 1989 May;32(5):652-9
references.pmid: 2655607
references.citation: Orthopedics. 1995 Oct;18(10):1029-32
references.pmid: 8584460
references.citation: J Spinal Disord. 1994 Feb;7(1):19-28
references.pmid: 8186585
references.citation: Spine (Phila Pa 1976). 1991 May;16(5):587-9
references.pmid: 2053005