title: Atlantoaxial instability after a header in an amateur soccer player.
abstract: METHODS
  Case report and literature review.
  
  
  OBJECTIVE
  To report a unique case of atlantoaxial instability after a header in a 37-year-old amateur soccer player and to discuss the injury pattern in relation to the impact of heading.
  
  
  BACKGROUND
  Although there is potential for cervical spine injuries, the rates in soccer are low compared with other contact or even noncontact sports. No cases of acute post-traumatic atlantoaxial instability after heading have ever been reported in a MEDLINE-listed article.
  
  
  METHODS
  A 37-year-old male soccer player experienced acute upper neck pain and transient quadriplegia after heading a long-distance ball on 2 occasions during a match. Imaging revealed atlantoaxial instability. Persistent neurological symptoms on conservative treatment led to his referral to our department. The considerable instability required surgical intervention.
  
  
  RESULTS
  Transarticular C1-C2 fixation and posterior fusion with structural iliac crest grafting were performed. The procedure immediately led to complete relief of the neurological symptoms. After an uneventful postoperative recovery, follow-up at 9 months revealed solid fusion. The patient remained symptom free.
  
  
  CONCLUSIONS
  Heading the ball in soccer can potentially lead to atlantoaxial instability. Ligamentous damage can theoretically be caused by anteriorly directed and rotational overload. However, the causative mechanism remains unclear. Diagnostic workup should consider dynamic imaging in players with transient neurological symptoms after minor trauma to the cervical spine.
  
  
  METHODS
  N/A.
authors.affiliation: From the Department of Spinal Surgery and Paraplegiology, Zentralklinik Bad Berka, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Werle
authors.forename: Kais Abu
authors.initials: KA
authors.lastname: Nahleh
authors.forename: Heinrich
authors.initials: H
authors.lastname: Boehm
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint / Q000293:injuries* / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D012916:Soccer / Q000293:injuries*