ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
In vivo three-dimensional kinematics of the upper cervical spine during upright head rotation in patients with atlantoaxial dislocation.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo quantify in vivo six-degree-of-freedom (6DOF) kinematics of the upper cervical spine during active head rotation in patients with atlantoaxial dislocation (AAD) and to compare the motion patterns with healthy adults.
methodsFifty-one imaging-confirmed AAD patients (23 men, 28 women; mean age 52 ± 15 years) performed left- and right-head rotation under dynamic fluoroscopic imaging system (DFIS). Subject-specific 3-D models of the skull and C1-C3 were reconstructed from computed tomography (CT), registered frame-by-frame, and expressed with an extrinsic Y-X-Z Euler sequence. Intersegmental range of motion (ROM) were contrasted with published normative datasets.
resultsAt C0-C1, flexion-extension (5.7 ± 3.6°) and lateral bending (4.6 ± 3.5°) were roughly 60% lower than controls (both P < 0.001), whereas axial rotation was similar (5.9 ± 5.3°, P = 0.67). Primary C1-C2 rotation fell to 38.1 ± 22.8° (controls 61.9 ± 13.5°, P < 0.001) accompanied by 3-fold increases in vertical and anteroposterior translations (both P < 0.001). C2-C3 showed compensatory gains: axial rotation 6.2 ± 8.5° vs. 3.1 ± 1.6° (P = 0.004) and larger translations on all axes (all P < 0.001). Motion was bilaterally symmetrical at C1-C2 and C2-C3, with only mild asymmetry in coupled lateral bending and mediolateral translation at C0-C1.
conclusionAAD markedly restricts C1-C2 rotation, stiffens occipito-atlantal nodding, and provokes hypermobility at C2-C3. These segment-specific 6DOF benchmarks enhance biomechanical insight into AAD pathomechanics and may refine surgical stability assessment.
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