Atlantoaxial instability

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Stability of the atlantoaxial junction is controlled by bone and ligament structures

    1. flexion is limited by the tectorial membrane (a continuation of the posterior longitudinal ligament)
    2. extension is limited by the anterior arch of C1 contacting the odontoid process
    3. anterior translation is limited by the transverse ligament
    4. rotation is limited by the alar ligaments
  1. a distance of more than 3 mm in the adult or 4.5 mm in a child between the posterior aspect of the anterior arch of C1 and the anterior surface of the dens is thought to represent an incompetent transverse ligament
  2. causes of atlantoaxial instability: trauma, rheumatoid arthritis, tumors, basilar invagination, os odontoideum, Down’s syndrome, ankylosing spondylitis
  3. treatment of choice: C1-C2 fixation and fusion
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