Presentation
Presented with ataxia since 3 months of age with neck pain.
Patient Data
On multiple projections of the neck, the cranial aspect of C2 is blunted and there is no evidence of a normal dens. The second cervical vertebra displaced dorsally relative to the first cervical vertebra. There is increased distance between the dorsal lamina of C1 and C2. On extension of the neck, there is minimal change. An endotracheal tube is in place secondary to anesthesia.
Case Discussion
Atlantoaxial instability and hypoplasia of the dens. The instability is due to malformation of the dens and lack of anchoring by the various ligaments between C1 and C2. Instability is sometimes more evident on flexed and extended images, which should be performed with caution as the spinal cord may be compressed with manipulation. CT provides additional detail regarding the relationship of C1 and C2, as well as osseous malformations.
The atlantoaxial joint was surgically stabilized with 8 screws and polymethylmethacrylate. 4 weeks later, his neurologic exam was normal.
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