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Atlantoaxial instability

MedGen UID:
98381
Concept ID:
C0410653
Disease or Syndrome
SNOMED CT: Atlantoaxial instability (202820009)
 
HPO: HP:0003467

Definition

Abnormally increased movement at the junction between the first cervical (atlas) and the second cervical (axis) vertebrae as a result of either a bony or ligamentous anomaly. [from HPO]

Term Hierarchy

Conditions with this feature

Down syndrome
MedGen UID:
4385
Concept ID:
C0013080
Disease or Syndrome
Down syndrome is a chromosomal condition that is associated with intellectual disability, a characteristic facial appearance, and weak muscle tone (hypotonia) in infancy. All affected individuals experience cognitive delays, but the intellectual disability is usually mild to moderate.\n\nPeople with Down syndrome often have a characteristic facial appearance that includes a flattened appearance to the face, outside corners of the eyes that point upward (upslanting palpebral fissures), small ears, a short neck, and a tongue that tends to stick out of the mouth. Affected individuals may have a variety of birth defects. Many people with Down syndrome have small hands and feet and a single crease across the palms of the hands. About half of all affected children are born with a heart defect. Digestive abnormalities, such as a blockage of the intestine, are less common.\n\nIndividuals with Down syndrome have an increased risk of developing several medical conditions. These include gastroesophageal reflux, which is a backflow of acidic stomach contents into the esophagus, and celiac disease, which is an intolerance of a wheat protein called gluten. About 15 percent of people with Down syndrome have an underactive thyroid gland (hypothyroidism). The thyroid gland is a butterfly-shaped organ in the lower neck that produces hormones. Individuals with Down syndrome also have an increased risk of hearing and vision problems. Additionally, a small percentage of children with Down syndrome develop cancer of blood-forming cells (leukemia).\n\nDelayed development and behavioral problems are often reported in children with Down syndrome. Affected individuals can have growth problems and their speech and language develop later and more slowly than in children without Down syndrome. Additionally, speech may be difficult to understand in individuals with Down syndrome. Behavioral issues can include attention problems, obsessive/compulsive behavior, and stubbornness or tantrums. A small percentage of people with Down syndrome are also diagnosed with developmental conditions called autism spectrum disorders, which affect communication and social interaction.\n\nPeople with Down syndrome often experience a gradual decline in thinking ability (cognition) as they age, usually starting around age 50. Down syndrome is also associated with an increased risk of developing Alzheimer's disease, a brain disorder that results in a gradual loss of memory, judgment, and ability to function. Approximately half of adults with Down syndrome develop Alzheimer's disease. Although Alzheimer's disease is usually a disorder that occurs in older adults, people with Down syndrome commonly develop this condition earlier, in their fifties or sixties.
Spondyloepiphyseal dysplasia, Reardon type
MedGen UID:
322238
Concept ID:
C1833603
Disease or Syndrome
Spondyloepiphyseal dysplasia, Reardon type is an extremely rare type of spondyloepiphyseal dysplasia (see this term) described in several members of a single family to date and characterized by short stature, vertebral and femoral abnormalities, cervical instability and neurologic manifestations secondary to anomalies of the odontoid process.
Odontoid hypoplasia
MedGen UID:
339524
Concept ID:
C1846439
Finding
The odontoid process, or dens, is a bony projection from the axis (C2) upward into the ring of the atlas (C1) at the top of the spine. During embryogenesis, the body of the odontoid derives from the centrum of the atlas and separates from the atlas, fusing with the superior portion of the axis. If the odontoid is hypoplastic or absent, the attachments for the apical and alar ligaments are missing, allowing for excessive rotation of the atlas, craniocervical instability, and possibly cord compression (summary by Stevens et al., 2009).
Spondyloepimetaphyseal dysplasia-short limb-abnormal calcification syndrome
MedGen UID:
338595
Concept ID:
C1849011
Disease or Syndrome
Spondylometaepiphyseal dysplasia, short limb-hand type is an autosomal recessive disorder with clinical and radiologic features of disproportionate short stature, platyspondyly, abnormal epiphyses and metaphyses, shortening of the lower and upper limbs, short and broad fingers, and premature calcifications. The disorder is progressive with respect to the severity of the bowing of the lower limbs and the appearance of calcifications, with some patients being wheelchair-bound from age 11 years (Bargal et al., 2009).
Spondyloepiphyseal dysplasia congenita
MedGen UID:
412530
Concept ID:
C2745959
Congenital Abnormality
Spondyloepiphyseal dysplasia congenita (SEDC) is an autosomal dominant chondrodysplasia characterized by disproportionate short stature (short trunk), abnormal epiphyses, and flattened vertebral bodies. Skeletal features are manifested at birth and evolve with time. Other features include myopia and/or retinal degeneration with retinal detachment and cleft palate (summary by Anderson et al., 1990).
Spondyloepimetaphyseal dysplasia, Maroteaux type
MedGen UID:
463613
Concept ID:
C3159322
Disease or Syndrome
The autosomal dominant TRPV4 disorders (previously considered to be clinically distinct phenotypes before their molecular basis was discovered) are now grouped into neuromuscular disorders and skeletal dysplasias; however, the overlap within each group is considerable. Affected individuals typically have either neuromuscular or skeletal manifestations alone, and in only rare instances an overlap syndrome has been reported. The three autosomal dominant neuromuscular disorders (mildest to most severe) are: Charcot-Marie-Tooth disease type 2C. Scapuloperoneal spinal muscular atrophy. Congenital distal spinal muscular atrophy. The autosomal dominant neuromuscular disorders are characterized by a congenital-onset, static, or later-onset progressive peripheral neuropathy with variable combinations of laryngeal dysfunction (i.e., vocal fold paresis), respiratory dysfunction, and joint contractures. The six autosomal dominant skeletal dysplasias (mildest to most severe) are: Familial digital arthropathy-brachydactyly. Autosomal dominant brachyolmia. Spondylometaphyseal dysplasia, Kozlowski type. Spondyloepiphyseal dysplasia, Maroteaux type. Parastremmatic dysplasia. Metatropic dysplasia. The skeletal dysplasia is characterized by brachydactyly (in all 6); the five that are more severe have short stature that varies from mild to severe with progressive spinal deformity and involvement of the long bones and pelvis. In the mildest of the autosomal dominant TRPV4 disorders life span is normal; in the most severe it is shortened. Bilateral progressive sensorineural hearing loss (SNHL) can occur with both autosomal dominant neuromuscular disorders and skeletal dysplasias.
Ehlers-Danlos syndrome, kyphoscoliotic type, 2
MedGen UID:
482790
Concept ID:
C3281160
Disease or Syndrome
FKBP14 kyphoscoliotic Ehlers-Danlos syndrome (FKBP14-kEDS) is characterized by congenital muscle hypotonia and weakness (typically improving during childhood), progressive scoliosis, joint hypermobility, hyperelastic skin, gross motor developmental delay, myopathy, and hearing impairment. Most affected children achieve independent walking between ages two and four years. A decline of motor function in adulthood may be seen, but affected individuals are likely to be able to participate in activities of daily living in adulthood and maintain independent walking. Occasional features underlying systemic connective tissue involvement include aortic rupture and arterial dissection, subdural hygroma, insufficiency of cardiac valves, bluish sclerae, bladder diverticula, inguinal or umbilical herniae, and premature rupture of membranes during pregnancy. Rarer findings may include bifid uvula with submucous or frank cleft palate, speech/language delay without true cognitive impairment, and rectal prolapse.
Smith-McCort dysplasia 1
MedGen UID:
854757
Concept ID:
C3888088
Disease or Syndrome
Any Smith-McCort dysplasia in which the cause of the disease is a mutation in the DYM gene.

Professional guidelines

PubMed

Tsou AY, Bulova P, Capone G, Chicoine B, Gelaro B, Harville TO, Martin BA, McGuire DE, McKelvey KD, Peterson M, Tyler C, Wells M, Whitten MS; Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup
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Terai H, Nakamura H
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Rhodes RE, Temple VA, Tuokko HA
Appl Physiol Nutr Metab 2011 Jul;36 Suppl 1:S113-53. doi: 10.1139/h11-041. PMID: 21800939

Recent clinical studies

Etiology

Stadler JA 3rd
Neurosurg Clin N Am 2022 Jan;33(1):61-65. Epub 2021 Oct 27 doi: 10.1016/j.nec.2021.09.012. PMID: 34801142
Figus FA, Piga M, Azzolin I, McConnell R, Iagnocco A
Autoimmun Rev 2021 Apr;20(4):102776. Epub 2021 Feb 17 doi: 10.1016/j.autrev.2021.102776. PMID: 33609792
Tsou AY, Bulova P, Capone G, Chicoine B, Gelaro B, Harville TO, Martin BA, McGuire DE, McKelvey KD, Peterson M, Tyler C, Wells M, Whitten MS; Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup
JAMA 2020 Oct 20;324(15):1543-1556. doi: 10.1001/jama.2020.17024. PMID: 33079159
Henderson FC Sr, Austin C, Benzel E, Bolognese P, Ellenbogen R, Francomano CA, Ireton C, Klinge P, Koby M, Long D, Patel S, Singman EL, Voermans NC
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Cormier-Daire V
Best Pract Res Clin Rheumatol 2008 Mar;22(1):33-44. doi: 10.1016/j.berh.2007.12.009. PMID: 18328979

Diagnosis

Tsou AY, Bulova P, Capone G, Chicoine B, Gelaro B, Harville TO, Martin BA, McGuire DE, McKelvey KD, Peterson M, Tyler C, Wells M, Whitten MS; Global Down Syndrome Foundation Medical Care Guidelines for Adults with Down Syndrome Workgroup
JAMA 2020 Oct 20;324(15):1543-1556. doi: 10.1001/jama.2020.17024. PMID: 33079159
Prasad A, Shah A, Sasane S, Goel A
World Neurosurg 2020 Sep;141:215-218. Epub 2020 Jun 18 doi: 10.1016/j.wneu.2020.06.102. PMID: 32565378
Henderson FC Sr, Austin C, Benzel E, Bolognese P, Ellenbogen R, Francomano CA, Ireton C, Klinge P, Koby M, Long D, Patel S, Singman EL, Voermans NC
Am J Med Genet C Semin Med Genet 2017 Mar;175(1):195-211. Epub 2017 Feb 21 doi: 10.1002/ajmg.c.31549. PMID: 28220607
Cormier-Daire V
Best Pract Res Clin Rheumatol 2008 Mar;22(1):33-44. doi: 10.1016/j.berh.2007.12.009. PMID: 18328979
King JE, Brumley MA
Nursing 2005 Nov;35(11):71. doi: 10.1097/00152193-200511000-00060. PMID: 16280938

Therapy

O'Connor FG, Leggit JC
FP Essent 2024 Sep;544:12-19. PMID: 39283673
Figus FA, Piga M, Azzolin I, McConnell R, Iagnocco A
Autoimmun Rev 2021 Apr;20(4):102776. Epub 2021 Feb 17 doi: 10.1016/j.autrev.2021.102776. PMID: 33609792
Neeraja K, Prasad S, Surisetti BK, Holla VV, Sharma D, Kamble N, Kulanthaivelu K, Dwarakanth S, Pruthi N, Pal PK, Yadav R
World Neurosurg 2021 Feb;146:e1287-e1292. Epub 2020 Dec 4 doi: 10.1016/j.wneu.2020.11.153. PMID: 33285336
Walia H, Ruda J, Tobias JD
Int J Pediatr Otorhinolaryngol 2016 Jan;80:5-7. Epub 2015 Nov 24 doi: 10.1016/j.ijporl.2015.11.007. PMID: 26746603
Botelho RV, de Souza Palma AM, Abgussen CM, Fontoura EA
Eur Spine J 2000 Oct;9(5):430-3. doi: 10.1007/s005860000166. PMID: 11057538Free PMC Article

Prognosis

Takeshima Y, Motoyama Y, Nakagawa I, Eura N, Saito K, Sugie K, Nakase H
Br J Neurosurg 2023 Dec;37(6):1835-1838. Epub 2021 Jun 26 doi: 10.1080/02688697.2021.1940854. PMID: 34180319
Akhtar MS, Rehman RU, Ali I
J Ayub Med Coll Abbottabad 2022 Jul-Sep;34(3):573-577. doi: 10.55519/JAMC-03-9848. PMID: 36377179
Ghanim MT, Bergmann S, Turner RD, Eskandari R, Mahajerin A
J Pediatr Hematol Oncol 2020 Aug;42(6):e518-e520. doi: 10.1097/MPH.0000000000001559. PMID: 31306336
Cormier-Daire V
Best Pract Res Clin Rheumatol 2008 Mar;22(1):33-44. doi: 10.1016/j.berh.2007.12.009. PMID: 18328979
Sagher O, Malik JM, Lee JH, Shaffrey CI, Shaffrey ME, Szabo TA, Jane JA
Neurosurgery 1993 Nov;33(5):926-8; discussion 928-9. doi: 10.1227/00006123-199311000-00025. PMID: 8264896

Clinical prediction guides

Figus FA, Piga M, Azzolin I, McConnell R, Iagnocco A
Autoimmun Rev 2021 Apr;20(4):102776. Epub 2021 Feb 17 doi: 10.1016/j.autrev.2021.102776. PMID: 33609792
Hedequist DJ, Mo AZ
J Am Acad Orthop Surg 2020 Feb 1;28(3):e100-e107. doi: 10.5435/JAAOS-D-18-00637. PMID: 31977608Free PMC Article
Zong R, Li T, Lu L, Qiao G, Yu X
World Neurosurg 2019 Jan;121:e70-e76. Epub 2018 Sep 11 doi: 10.1016/j.wneu.2018.09.014. PMID: 30213673
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J Pediatr Orthop 1993 May-Jun;13(3):318-21. doi: 10.1097/01241398-199305000-00008. PMID: 8496364

Recent systematic reviews

Isaacs AM, Narapareddy A, Nam A, Hutcheson K, Stone M, Bonfield CM
J Neurosurg Pediatr 2023 Aug 1;32(2):163-172. Epub 2023 Apr 28 doi: 10.3171/2023.3.PEDS22353. PMID: 37119098
Mansfield CJ, Domnisch C, Iglar L, Boucher L, Onate J, Briggs M
J Man Manip Ther 2020 May;28(2):72-81. Epub 2019 Sep 17 doi: 10.1080/10669817.2019.1667045. PMID: 31526113Free PMC Article
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World Neurosurg 2019 Jun;126:e125-e135. Epub 2019 Feb 18 doi: 10.1016/j.wneu.2019.01.267. PMID: 30790735
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World Neurosurg 2019 Jan;121:100-110. Epub 2018 Oct 11 doi: 10.1016/j.wneu.2018.10.011. PMID: 30315972
Brockmeyer D
Pediatr Neurosurg 1999 Aug;31(2):71-7. doi: 10.1159/000028837. PMID: 10592475

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