Yıl: 2021 Cilt: 33 Sayı: 4 Sayfa Aralığı: 265 - 267 Metin Dili: İngilizce DOI: 10.14744/agri.2019.73555 İndeks Tarihi: 12-01-2022

Unilateral isolated alar ligament rupture in an adult female patient

Öz:
Only seven cases of isolated unilateral rupture of the alar ligament had been previously reported. The authors report the first adult female case of this rare injury. The patient in their case, a 36-year-old female presented after a trauma due to falling, and at that moment, she had fainted due to a sudden pain between the neck and head. The radiological examinations [magnetic resonance imaging (MRI) and X-rays] had been interpreted as normal. She had a positive Alar ligament test at the right side, and a thin section craniovertebral junction computed tomography was obtained which revealed an asymmetrically left-sided odontoid process and a new MRI revealed a right-sided alar ligament rupture. Thus she underwent a bilateral greater occipital nerve block together with pulse radiofrequency and trigger point injection at splenius capitis, levator scapula, and trapezius followed by the application of a halo orthosis to be worn for 3 months. The patient was found to be pain-free in the follow-up examinations. With pure unilateral alar ligament rupture, the atlantooccipital joint is not disrupted and the craniovertebral junction is not destabilized. To date, only eight cases of isolated unilateral alar ligament rupture have been reported one of which was a 25 years old male; all of whom presented with marked neck pain and treated by external immobilization for 4 weeks to 4 months and our case is the first adult female patient.
Anahtar Kelime:

Erişkin bir kadın hastada tek taraflı izole alar ligaman rüptürü

Öz:
Daha önce tek taraflı izole alar ligament rüptürü yedi vaka bildirilmiştir. Yazarlar, bu nadir yaralanmanın ilk yetişkin kadın olgu- sunu bildirmektedir. 36 yaşında kadın hasta düşme sonrası merkezimize başvurdu. Düşme esnasında aldığı travma sonucu baş- layan boyun ve baş arasında yoğun ağrı tarifledi. Radyolojik incelemeler (manyetik rezonans görüntüleme ve grafiler) normal olarak yorumlandı. Muayenesinde sağ tarafta alar ligaman testi pozitif bulundu. Çekilen ince kesitli baş boyun bileşke tomog- rafisinde odontoid proçesin sol tarafta asimetrik olduğu farkedildi. Sonrasında çekilen menyetik rezonans görüntülemede izole sağ alar ligaman rüptürü saptandı. Bu nedenle hastaya iki taraflı oksipital sinir blokajı, pulsed radyofrekans ve splenius capitis, levator scapula, trapezius kaslarına tetik nokta enjeksiyonu uygulanarak hasta üç ay boyunca halo ortez ile takip edildi. İlerleyen takiplerinde hastanın ağrısız olduğu gözlendi. Tek taraflı izole alar ligaman rüptürü ile atlantooksipital eklemde ayrışma gözlen- mezken, kraniovertebral bileşkede instabilite gelişmediği gözlendi. Günümüze kadar izole alar ligaman rüptürü 8 kez rapor edil- miş olup bunlardan sadece biri 25 yaşında erkekti. Diğer hastalar çocukluk çağındaydı. Tüm olguların 4 hafta ile 4 aylık eksternal fiksatörlerle tedavi edildiği gözlendi. Bizim olgumuz ise tek taraflı izole alar ligaman rüptürü gelişen ilk erişkin kadın hastadır.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Olgu Sunumu Erişim Türü: Erişime Açık
  • 1. Wong ST, Ernest K, Fan G, Zovickian J, Pang D. Isolated uni- lateral rupture of the alar ligament. J Neurosurg Pediatr 2014;13(5):541–7.
  • 2. Dvorak J, Panjabi MM. Functional anatomy of the alar liga- ments. Spine (Phila Pa 1976) 1987;12(2):183–9.
  • 3. Heller JG, Amrani J, HuttonWC. Transverse ligament failure: A biomechanical study. J Spinal Disord 1993;6(2):162–5.
  • 4. Karray M, M’nif N, Mestiri M, Kooli M, Ezzaouia K, Zlitni M. Concomitant alar and apical ligament avulsion in atlanto- axial rotatory fixation. Case report and review of the litera- ture. Acta Orthop Belg 2004;70(2):189–92.
  • 5. Pang D, Nemzek WR, Zovickian J. Atlanto-occipital dis - location part 2: The clinical use of (occipital) condyle-C1 interval, comparison with other diagnostic methods, and the manifestation, management, and outcome of atlanto-occipital dislocation in children. Neurosurgery 2007;61(5):995–1015; discussion 1015.
  • 6. Saternus KS, Thrun C. Traumatology of the alar ligaments. Aktuelle Traumatol 1987;17(5):214–8.
  • 7. Bloom AI, Neeman Z, Floman Y, Gomori J, Bar-Ziv J. Occipi- tal condyle fracture and ligament injury: imaging by CT. Pediatr Radiol 1996;26(11):786–90.
  • 8. Lummel N, Zeif C, Kloetzer A, Linn J, Brückmann H, Bitter- ling H. Variability of morphology and signal intensity of alar ligaments in healthy volunteers using MR imaging. AJNR Am J Neuroradiol 2011;32(1):125–30.
  • 9. Osmotherly PG, Rivett DA, Mercer SR. Revisiting the clinical anatomy of the alar ligaments. Eur Spine J 2013;22(1):60–4.
  • 10. Briem D, Linhart W, Dickmann C, Rueger JM. Injuries of the alar ligaments in children and adolescents. Unfallchirurg (Ger) 2002;105(6):555–9.
  • 11. Caird MS, Hensinger RN, Vander Have KL, Gelbke MK, Far- ley FA. Isolated alar ligament disruption in children and ad- olescents as a cause of persistent torticollis and neck pain after injury. A report of three cases. J Bone Joint Surg Am 2009;91(11):2713–8.
  • 12. Baumert B, Wörtler K, Steffinger D, Schmidt GP, Reiser MF, Baur-Melnyk A. Assessment of the internal craniocervi- cal ligaments with a new magnetic resonance imaging sequence: Three-dimensional turbo spin echo with vari- able flip-angle distribution (SPACE). Magn Reson Imaging 2009;27(7):954–60.
  • 13. Krakenes J, Kaale BR, Moen G, Nordli H, Gilhus NE, Rorvik J. MRI assessment of the alar ligaments in the late stage of whiplash injury: A study of structural abnormalities and observer agreement. Neuroradiology 2002;44(7):617–24.
  • 14. Myran R, Kvistad KA, Nygaard OP, Andresen H, Folvik M, Zwart JA. Magnetic resonance imaging assessment of the alar ligaments in whiplash injuries: A case-control study. Spine 2008;33(18):2012–6.
  • 15. Mathern GW, Batzdorf U. Grisel’s syndrome. Cervical spine clinical, pathologic, and neurologic manifestations. Clin Orthop 1989;244:131–46.
  • 16. Dvorak J, Penning L, Hayek J, Panjabi MM, Grob D, Zehnder R. Functional diagnostics of the cervical spine using com- puter tomography. Neuroradiology 1988;30(2):132–7.
  • 17. Radcliff KE, Hussain MM, Moldavsky M, Klocke NF, Vaccaro A, Albert TJ, et al. Stabilization of the craniocervical junc- tion after an internal dislocation injury: An in vitro study. Spine J 2015;15(5):1070–6.
APA KESKİL S, yüksel u, BİLGİLİ Y, BABACAN A (2021). Unilateral isolated alar ligament rupture in an adult female patient. , 265 - 267. 10.14744/agri.2019.73555
Chicago KESKİL Semih,yüksel ulaş,BİLGİLİ Yasemin KARADENİZ,BABACAN Avni Unilateral isolated alar ligament rupture in an adult female patient. (2021): 265 - 267. 10.14744/agri.2019.73555
MLA KESKİL Semih,yüksel ulaş,BİLGİLİ Yasemin KARADENİZ,BABACAN Avni Unilateral isolated alar ligament rupture in an adult female patient. , 2021, ss.265 - 267. 10.14744/agri.2019.73555
AMA KESKİL S,yüksel u,BİLGİLİ Y,BABACAN A Unilateral isolated alar ligament rupture in an adult female patient. . 2021; 265 - 267. 10.14744/agri.2019.73555
Vancouver KESKİL S,yüksel u,BİLGİLİ Y,BABACAN A Unilateral isolated alar ligament rupture in an adult female patient. . 2021; 265 - 267. 10.14744/agri.2019.73555
IEEE KESKİL S,yüksel u,BİLGİLİ Y,BABACAN A "Unilateral isolated alar ligament rupture in an adult female patient." , ss.265 - 267, 2021. 10.14744/agri.2019.73555
ISNAD KESKİL, Semih vd. "Unilateral isolated alar ligament rupture in an adult female patient". (2021), 265-267. https://doi.org/10.14744/agri.2019.73555
APA KESKİL S, yüksel u, BİLGİLİ Y, BABACAN A (2021). Unilateral isolated alar ligament rupture in an adult female patient. Ağrı, 33(4), 265 - 267. 10.14744/agri.2019.73555
Chicago KESKİL Semih,yüksel ulaş,BİLGİLİ Yasemin KARADENİZ,BABACAN Avni Unilateral isolated alar ligament rupture in an adult female patient. Ağrı 33, no.4 (2021): 265 - 267. 10.14744/agri.2019.73555
MLA KESKİL Semih,yüksel ulaş,BİLGİLİ Yasemin KARADENİZ,BABACAN Avni Unilateral isolated alar ligament rupture in an adult female patient. Ağrı, vol.33, no.4, 2021, ss.265 - 267. 10.14744/agri.2019.73555
AMA KESKİL S,yüksel u,BİLGİLİ Y,BABACAN A Unilateral isolated alar ligament rupture in an adult female patient. Ağrı. 2021; 33(4): 265 - 267. 10.14744/agri.2019.73555
Vancouver KESKİL S,yüksel u,BİLGİLİ Y,BABACAN A Unilateral isolated alar ligament rupture in an adult female patient. Ağrı. 2021; 33(4): 265 - 267. 10.14744/agri.2019.73555
IEEE KESKİL S,yüksel u,BİLGİLİ Y,BABACAN A "Unilateral isolated alar ligament rupture in an adult female patient." Ağrı, 33, ss.265 - 267, 2021. 10.14744/agri.2019.73555
ISNAD KESKİL, Semih vd. "Unilateral isolated alar ligament rupture in an adult female patient". Ağrı 33/4 (2021), 265-267. https://doi.org/10.14744/agri.2019.73555