T.G. SAKOVETS, E.I. BOGDANOV

 Kazan State Medical University, Kazan

Contact details:

Sakovets T.G, PhDCand. Sci. (Medicine), Associate Professor of the Department of Neurology

Address: 49 Butlerov St., 420012 Kazan, Russian Federation, tel.: +7-917-924-99-79, e-mail: tsakovets@yandex.ru

 Atlantoaxial subluxation occurs in a number of injuries and diseases of the craniovertebral junction, including trauma, inflammation, malignancies, and rheumatological conditions. Nonspecific complaints, such as headaches, nonsystemic dizziness, general weakness, fatigue, visual impairment, and postural instability, are common in children and adolescents. A careful examination reveals atlantoaxial subluxation. A new hypothesis regarding the origin of craniovertebral junction anomalies has recently been proposed. It is suggested that atlantoaxial instability, frequently encountered in patients with these anomalies, may be the cause of both Chiari I malformation and basilar invagination, rendering the tried and tested surgical decompression strategy ineffective. A number of authors believe that Chiari malformation and atlantoaxial instability may coexist. In turn, some authors propose fusion at the C1-2 level as the only solution for all craniovertebral junction anomalies. The revised definition of atlantoaxial instability suggests that fusion is performed in both patients with and without radiographic signs of instability, relying on intraoperative assessment of the atlantoaxial joints to confirm instability. Thus, the question of the primary importance of atlanto-axial subluxation and Chiari malformations in the clinical symptoms remains open, requiring careful patient selection for neurosurgical intervention.

Key words: Chiari malformation, atlantoaxial instability.

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