Conservative management of idiopathic anterior atlantoaxial subluxation without neurological deficits in an 83-year-old female: A case report

Abstract

Atlantoaxial subluxation that is not related to traumatic, congenital, or rheumatological conditions is rare and can be a diagnostic challenge. This case report details a case of anterior atlantoaxial subluxation in an 83-year-old female without history of trauma, congenital, or rheumatological conditions. She presented to the chiropractor with insidious neck pain and headaches, without neurological deficits. Radiographs revealed a widened atlantodental space (measuring 6 mm) indicating anterior atlantoaxial subluxation and potential sagittal atlantoaxial instability. Prompt detection and appropriate conservative management resulted in favourable long-term outcome at 13-months follow-up. Conservative management included education, mobilizations, soft tissue therapy, monitoring for neurological progression, and co-management with the family physician. The purpose of this case report is to heighten awareness of the clinical presentation of idiopathic anterior atlantoaxial subluxation without neurological deficits. Discussion will focus on the incidence, mechanism, clinical presentation, and conservative management of a complex case of anterior atlantoaxial subluxation.

Keywords: atlantoaxial subluxation; atraumatic; conservative management; idiopathic; upper cervical.

Figure 1A:

Lateral Cervical Radiograph Bone density is moderately diminished, but vertebral body heights were well maintained and no congenital bony anomaly was visualized. Cervical lordosis is mildly reversed with a large atlantodental space measuring 6 mm. The space available for spinal cord (SAC) measures 15 mm at C1. Disc narrowing with bone spurring is noted from C3–7. The sagittal spinal canal is narrowed measuring 12 mm at C4 and 9 mm at C5. The facet joints and prevertebral soft tissue are unremarkable.

Figure 1B:

Anterior Posterior Open Mouth Cervical Radiograph Mild joint space narrowing is noted in the right C1–2 articulation.

Figure 1C:

Anterior Posterior Lower Cervical Radiograph Uncinate blunting is noted at C4, C5, C6 and C7. The facet joints are unremarkable. Calcific plaques are noted at the aortic knob.