J Korean Soc Radiol.  2010 Jan;62(1):1-6. 10.3348/jksr.2010.62.1.1.

Hemodynamic Alteration of the Cervical Venous Circulation in a Patient Suffering From Atlantoaxial Degenerative Osteoarthritis with Subluxation: A Case Report

• Lee H
• Lee SH
• Choi WG
• Tsang YS
• Lee SJ
• Hwang BW

• KMID: 2208986
• DOI: http://doi.org/10.3348/jksr.2010.62.1.1

Abstract

A 52-year-old female patient was admitted to our hospital with severe occipitocervical pain. The radiographic examination revealed degenerative osteoarthritis and subluxation of the right atlantoaxial joint. Her pain was completely and immediately relieved after occipitocervical reduction and fusion. The marked dilatation of the extradural venous plexus around the vertebral artery and the enlarged deep cervical veins seen on the preoperative MR images had returned to normal dimensions on the postoperative MR images, and this explained the observed rapid pain relief. We report here on this case together with a review of the relevant literature.

MeSH Terms

Atlanto-Axial Joint
Dilatation
Female
Hemodynamics
Humans
Hyperemia
Magnetic Resonance Imaging
Middle Aged
Osteoarthritis
Stress, Psychological
Veins
Vertebral Artery

Figure

• 

  Fig. 1 A. An open mouth view showed degenerative osteoarthritis of the right atlantoaxial joint with left lateral listhesis of C1 on C2. B. The coronal reconstructed CT image more clearly depicts the joint space narrowing, the subchondral sclerosis, the peripheral osteophyte formation and the erosions of the right atlantoaxial joint.

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  Fig. 2 Plain radiographs of the cervical spine on flexion (A) and extension (B) showing the atlanto-axial subluxation. The changing distance on flexion suggests subluxation. Note that on extension there is a reduction of the subluxation.

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  Fig. 3 The axial gradient-echo T2*-weighted (A) and contrast-enhanced spin echo T1-weighted (B) MR images showing a significant dilatation of the suboccipital cavernous sinus (large solid arrow), the internal and external vertebral venous plexuses (large open arrow) and the deep cervical veins (small solid arrows).

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  Fig. 4 The plain anteroposterior and lateral radiographs taken after occipitocervical reduction and fusion.

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  Fig. 5 The axial gradient-echo T2*-weighted (A) and contrast-enhanced spin echo T1-weighted (B) MR images after surgery showing that the vertebral venous plexuses and deep cervical veins have returned to normal.

Reference

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