Trinity Medical Center I Dr. Marin Guentchev, MD, PhD Acquired occipitocervical instability

Acquired occipitocervical instability

ANATOMY OF THE SPINE

The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.
Normal anatomy of the spine. Longitudinal section and cross sections through the cervical, thoracic and lumbar spine.
The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid. The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus). The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.
The connection between the head and the spine is the atlanto-occipital joint. It consists of the condyles of the occipital bone and the upper joint surfaces of the 1st cervical vertebra. The 1st cervical vertebra is called the atlas. The atlas is connected to the 2nd cervical vertebra (axis) below as well.

DESCRIPTION

Acquired occipitocervical instability is a pathological condition of increased mobility at the craniocervical junction. Acquired occipitocervical instability usually develops as a result of an inflammatory disease (e.g. rheumatoid arthritis) or a congenital disorder (e.g. Down's Syndrome).

CAUSE OF SYMPTOMS

Gradually progressing inflammation and degeneration in the intervertebral joints in the cervical spine
Lower cranial nerve (IX, X, and XI) injury

SYMPTOMS AND SIGNS

Numbness, weakness, stiffness in the limbs and ataxic gait. Symptoms begin gradually and tend to worsen over months and years.
Pain and stiffness in the neck Pain in the hands and shoulders (pseudoradicular type)
Paralysis of tongue and soft palate

THE DIAGNOSIS IS BASED ON

Medical history Clinical exam Computer tomography Radiographs Magnetic resonance imaging (MRI)

TREATMENT

WHEN SHOULD AN OPERATION BE PERFORMED?

Symptomatic acquired occipitocervical instability requires surgical treatment. Traction should be avoided (10 % risk of neurological deterioration).

WHAT IS THE GOAL OF SURGERY?

To restore the protective function of the spine
To restore the protective function of the spine

HOW IS SURGERY PERFORMED?

Posterior occipitocervical fusion and if necessary decompression

WHICH OTHER DISEASES SHOULD BE EXCLUDED (DIFFERENTIAL DIAGNOSIS)?

Other fractures of the spine Cervical facet joint pain Cervical disc herniation Ankylosing spondylitis (Bechterew's disease) Vertebral fractures
Adress
Trinity Medical Center 117 Zaichar St /Ground floor/ /Konstantin Velichkov Metro Station/ BG-1309 Sofia, Bulgaria
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