Avni BABACAN, Semih KESKİL, Ulaş YÜKSEL, Yasemin KARADENİZ BİLGİLİ

Erişkin bir kadın hastada tek taraflı izole alar ligaman rüptürü

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.

Unilateral isolated alar ligament rupture in an adult female patient

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.

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