Obsessive head and neck tilt deformity

Introduction Patients with unilateral facet joint dislocation have prominent local neck symptoms, pain, compulsive head and neck tilt deformity, cervical spine extension and rotational function limitation.

Cause

[Pathogenesis]

Similar to the flexion injury, when the head and neck are subjected to flexion and impact, the neck not only flexes but also rotates to one side. When the buckling and rotating external force acts on the cervical vertebra at the same time, the injured segment forms a twisting violence forward and downward, with the central portion of the posterior disc as the axis, and the upper cervical subarachnoid on one side rotates backward, while the other lower joint is protruded. The front slides and passes over the upper joint of the lower vertebral body to the front to form an "interlocking" state (Fig. 1). The upper and lower articular processes collide with each other and can also cause joint fractures.

[pathological changes]

The joint capsule tear of the bilateral articular process, the anterior longitudinal ligament, the posterior longitudinal ligament, the intervertebral disc and the posterior ligament complex structure can be damaged. Since the dislocated joint is located in front of the superior articular process, the intervertebral foramen are deformed or narrowed, and the nerve root is easily damaged. This dislocation is considered to be a relatively "stable" state of cervical spine injury, but the two facet joint faces on the non-dislocated side are separated from each other. The intervertebral disc annulus is subject to sustained rotational stress. This asymmetry dislocation causes the spinal canal to deform and narrow in the plane of injury, which can cause spinal cord injury.

an examination

Related inspection

CT examination of bone and joint and soft tissue CT examination of brain

The clinical manifestations of this disease mainly have the following two aspects:

1. Local symptoms of the neck are more prominent, pain, compulsive head and neck tilt deformity, cervical spine extension and rotation function are limited.

2, combined with spinal cord and nerve root injury manifested as the symptoms of the corresponding spinal segment: quadriplegia, lower limb paralysis or partial paralysis. In the case of nerve root injury, the skin is hypersensitive to the skin, and the pain or sensation is reduced.

Differential diagnosis

Limited head and neck activity: one of the symptoms of cervical spondylosis, head, neck, shoulders, back, arms sore, neck and neck stiffness, limited mobility.

Abnormal cervical segmentation: cervical segmental malformation, also known as cervical fusion deformity, is a fusion of two or more cervical vertebrae, which is characterized by a decrease in the number of cervical vertebrae, a shortened neck, limited head and neck movement, and often accompanied by other parts. Malformation, a small number of patients may be associated with neurological disorders.

Separation of head and neck: It is one of the clinical manifestations of a gallow fracture or a traumatic vertebral arch fracture. Clinical manifestations: mainly neck symptoms, there is a sense of separation of the head and neck, patients like to hold the head by hand; it should be noted that about 15% of cases can have spinal symptoms.

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