Cuéllar PJA

Language: Spanish
References: 18
Page: 234-242
PDF size: 225.31 Kb.

ABSTRACT

The complexity of the atlantoaxial joint is implicit in its origin, structure and function. Since this is a joint without a direct or indirect reference with the rest of the spine, its instabilities have always been difficult to understand. This paper presents a straightforward approach that shows the importance of knowing the anatomy and physiology of this joint, since the correlation between the basic concepts and the conditions and their treatments is indispensable. To this end we refer to the intrinsic and extrinsic elements related to this joint, which are punctually and clearly involved in the concept of stability. We also describe the most frequent diseases and lesions that cause a structural and eventually, a neurological compromise; we assign a special space and description to rheumatoid arthritis, a condition that has always been characterized by a complicated diagnosis and management. We also mention tumor, infectious, traumatic and congenital lesions that warrant posterior atlanto-axoid stabilization. We finally address the classical surgical approaches, which continue to be used due to the “low technical demand” (wires and cables) needed to perform them, the contemporary options, which we have had for more than twenty years (screws, hooks) and are increasingly used, and the cutting edge options that, in an attempt to be recognized and popular (facet spacers, screws), often reach the absurd. The latter approaches may be amazingly bold and ineffective in some cases, or simple and partially effective in others. The knowledge supporting them is so weak that techniques with different advantages are combined in an attempt to control the rotational and anteroposterior planes of this joint. It is possible to conclude that at present there is no solution that is straightforward, effective and safe all at the same time.

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