CCJ is a highly mobile complex junctional zone between skull and spinal column, which comprises the atlanto-occipital and the atlanto-axial joints and houses the spinal cord, multiple cranial nerves etc. Ligaments play a very important role in providing stability and deciding the limits of movements. The joints are responsible for the majority of the movement of the cervical spine and operate on different biomechanical principles.
The mechanical properties of atlantooccipital joint and atlantoaxial joint are determined by bony structures and ligamentous structures respectively. These 2 joints function togetherly to ensure optimal stability and mobility at the CCJ.
The transverse ligament is the major stabilizing ligament and permits rotation to occur while the alar ligaments prevent excessive rotation.
Injuries to CCJ is not uncommon particularly due to RTA and fall from height. Out of various conditions Rheumatoid arthritis is the most common arthropathy of the cervical spine causing inflammation of the joints in the CCJ leading to the instability of the atlantoaxial joint. Infections though rare but pyogenic and tuberculosis may do occur.
The patient presented with a H/O fall from bicycle 2 weeks back leading to weakness of B/L upper and lower limbs with associated abnormal sensation over back of head, neck & upper most part of chest.
There was no other injuries and bladder and bowel was normally functioning. On clinical evaluation his power at C5-T1 and L2-S1 levels was 3/5 on the Right side and 4/5 on the Left side with bilateral impaired sensation over the C2, 3, 4 dermatomes and Clinicoradiologically he has been diagnosed as atlanto axial subluxation and Open reduction and internal fixation with Drummond wire was done.