Atlas Hypoplasia Combined with Atlantoaxial Subluxation is a Cause of Non-traumatic Cervical Myelopathy

寰椎成形不全合併寰椎─樞椎滑脫導致非創傷性頸椎脊髓病變

李漢忠(Han-Chung Lee) ； 謝柏均(Po-Chun Hsieh) ； 周德陽(Der-Yang Cho)

《Mid-Taiwan Journal of Medicine》 8卷2期 (2003/06) Pp. 99-104

https://doi.org/10.6558/MTJM.2003.8(2).7

摘要

寰椎後椎弓的先天異常並不常見，它們可細分為後椎弓局部椎裂到完全缺失。寰椎成形不全可以導致成年人頸椎壓迫及脊髓病變。本篇，我們報告一個因寰椎成形不全合併寰椎-樞椎滑脫的案例，她並無創傷病史卻於近六個月來發展成頸椎脊髓病變，神經影像學檢查發現寰椎後椎弓單側裂及樞椎突前空間過寬導致頸椎脊髓明顯壓迫而造成頸椎脊髓病變，此病例在接受寰椎成形不全的後椎可切除及後位枕骨-第三頭椎融合手術後有明顯的神經學改善，寰椎後椎弓成形不全可以導致惟管明顯狹窄，若又合併寰椎-樞椎滑脫則會加重頸椎脊性的先天性狹窄而造成頸椎脊髓病變，後側減壓手術切除寰椎成形不全的後椎弓和周邊退化的韌帶加上枕骨-第三頸椎融合對這頗有神經症狀的病人是一項有效的治療。

關鍵字

寰椎成形不全,寰椎-樞惟涓脫,頸椎椎管狹窄,頸椎脊髓病變,後位枕骨-第三頸椎融合

並列摘要

Congenital abnormalities of the posterior arch of the atlas (C-1) are uncommon. They may range from partial clefts to total agenesis of the posterior arch. Atlas hypoplasia may cause segmental compression and cervical myelopathy in elderly patients. In this report, we present a case of atlas hypoplasia combined with atlantoaxial subluxation. The patient developed cervical myelopathy gradually for 6 months without preceding trauma. Neuroimaging studies revealed a unilateral cleft of the posterior Cl arch and widening of the predental space which caused followed the removal of the hypoplastic C-l arch and the constricted ligament along with posterior occipital-C-3 fusion. Hypoplastic posterior arch of C-l may create marked focal stenosis of the spinal canal and the cord may be further compromised by atlantoaxial subluxation. Posterior decompression combined- with occipital-C-3 fusion is an effective treatment for symptomatic patients with such a condition.

並列關鍵字

atlas hypoplasia,atlantoaxial subluxation,cervical canal stenosis,cervical myelopathy,posterior occipital-C-3 fusion