Backward Luxation of the Atlas

Abstract

Backward luxation of the atlas would appear to be an extremely rare con dition. A number of authors mention the infrequency of backward luxation as compared to the more common forward luxation although no single unequiv ocal report of this condition could be found in an extensive study of the literature. According to MALGAIGNE (1) a case was described in 1850 by MELCHIORI in Italy ; it was not possible however to obtain the original of this paper. There would therefore appear to be some justification for the publica tion of the present case in which post-mortem confirmation of the diagnosis was possible. Case reportA 66-year-old houswife with a history of recurrent rheumatoid arthritis since the age of 28. She had had several attacks, for which she had received gold, salicylates and pyridine deriv atives, followed by stiffness of the joints particularly the knees, left shoulder, wrists and interphalangeal joints. She was admitted with severe pain in the nuchal region, tender and swollen knees and a temperature of 39° C. The sedimentation rate was 132 mm/hours and the Rose

Backward luxation of the atlas. Two cases of an uncommon condition.

“…We have been able to find in the world literature only one previous case, reported by Verjaal and Harder (1965). This patient, also suffering from chronic seropositive rheumatoid arthritis, was a 66-year-old housewife with widespread joint involvement and a high ESR, who had been treated with gold, salicylates, and pyridine derivatives.…”

“…Verjaal and Harder (1965) did not present evidence to exclude the possibility that it was a rheumatoid nodule, rather than, as stated, a meningioma. For backward luxation of the atlas to occur the anterior arch of the atlas must be destroyed or congenitally absent, or the odontoid process must be fractured, destroyed, or congenitally absent.…”

Posterior Atlanto-Axial Subluxation In Rheumatoid Arthritis

“…in the 5 previously described cases varied. In 2 of the patients, the odontoid process had been destroyed (4, 9). In one of these cases (9) the anterior arc of the atlas was also absent.…”

Rheumatoid C1--C2 dislocation: pathogenesis and treatment reconsidered

“…Review of necropsy reports of 12 patients who died of dislocation of C1 on C2 vertebra due to rheumatoid arthritis (Davis and Markley, 1951;Martel and Page, 1960;Martel and Abell, 1963;Gleason and Urist, 1965;Verjaal and Harder, 1965;Bland, 1967;Webb et al, 1968) shows that incompetence of the transverse ligament of C1 vertebra was found in only three patients (Martel and Abell, 1963;Webb et al, 1968). Of these three patients, two died of upper cervical cord compression from the displaced odontoid process (Martel and Abell, 1963).…”

“…Significant rheumatoid granulation tissue was found be-tween the anterior arch of C1 vertebra and the odontoid process on six occasions (Gleason and Urist, 1965;Bland, 1967), in the retro-odontoid space on two occasions (Martel and Abell, 1963;Gleason and Urist, 1965), and between C4 and C5 vertebrae on one occasion (Bland, 1967). In one patient backward dislocation of C1 vertebra due to rheumatoid process was associated with a large intraspinal meningioma attached to the body of C2 vertebra (Verjaal and Harder, 1965).…”