In Greek mythology, Atlas was condemned, for having displeased Zeus, to carry the weight of the entire celestial vault on his shoulders. For this reason, the first (C1) of the seven vertebrae of the cervical spine, the one which has the delicate task of supporting the skull, is called the ‘atlas’. The point of contact between this vertebra with a particular shape, the second cervical vertebra (the so-called axis tooth) and the skull base is called craniocervical junction. “It is a very delicate point – explains Massimiliano Visocchi, associate of neurosurgery at the Catholic University of the Sacred Heart and director of the Cranio-cervical Junction Surgery Unit, Gemelli Irccs Polyclinic Foundation – which can be affected by a series of inflammatory pathologies, degenerative, neoplastic and traumatic which can give rise to aspondylolisthesis‘, i.e. the ‘head sliding down the neck disease’“.
When it can appear, how to recognize it
“This type of condition – he continues – can appear in people with metabolic problems (Down syndrome, mucopolysaccharidosis, hyperparathyroidism, Paget’s disease), inflammatory problems (rheumatoid arthritis, Griesel syndrome), with tumors of the cranio-cervical junction, but also in following a traumatic event such as a car accident, a slap on the back of the head, an accident during a tennis or football match, a fall while skiing, leading to a fracture of the first or second cervical vertebra and a dislocation of the cranio-cranial junction cervical. All these problems can lead to spinal instability which must generally be resolved surgically – he underlines – urgently in the case of a traumatic accident or electively in other pathologies”.
Symptoms, how to treat it
The symptoms of this condition can be different. “The patient may present pain that occurs with head movements, tingling in the limbs, an unstable gait (so-called ataxic or paraparetic). In some cases there may be a loss of control of the urinary sphincter”, lists Visocchi. Faced with these symptoms the neurosurgeon will ask for radiological investigations. “The dynamic radiography will highlight the anomalous relationship between the first cervical vertebrae and the skull base, in relation to the head movements”, while the CT scan and MRI will allow for an in-depth assessment of the damage to be treated.
In less serious cases, an attempt can be made to reduce this dislocation by positioning the so-called Halo-Vest collar, a metal areola around the head, fixed with screws to the skull and connected with metal bars to a sort of rigid thoracic corset. “It is a temporary external restraint system, which is worn for a few months and can act as a bridge to surgery – explains Visocchi – which immobilizes and protects the cervical spine and neck after a fracture or dislocation of the first cervical vertebrae In some types of fracture, immobilization with Halo-Vest leads to healing by consolidation of the vertebra. In other cases, it is necessary to resort to surgery, which consists of blocking these vertebrae together, using four screws and two titanium bars. In the past the skull was blocked over the entire neck, while today the skull base is blocked only on the first two cervical vertebrae”.
The operation lasts approximately 3 hours and no rehabilitation is necessary. But this is a complex operation for which it is best to rely on centers with great experience. “Over the last 10 years – concludes the expert – we have worked on around a hundred cases: we are a reference center in Italy and also the only university in the world that has a research centre, a second level master’s degree and an operational unit, expressly dedicated to surgery of the cranio-cervical junction”.
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