Physical Exam On palpation, the examiner may find crepitus at the neck joint and unstable movement including a positive "clunk test" (palpable subluxation). Lhermitte's sign may be elicited with head flexion. Radiographic Imaging As many as 50\% of patients with radiographic instability are actually asymptomatic. Initial radiography should include flexion and extension lateral X-rays in addition to static anterior/posterior and lateral views. These views are often repeated every 2–3 years, especially in patients with new symptoms or possibly requiring future intubation. Progression of disease is measured via anterior atlantodental interval (AADI), and posterior atlantodental interval (PADI). Other techniques include the Ranawat Index, MacGregor Line, the Clark stations, and the Redlund-Johnell measurement.
Physical exam On palpation, the examiner may find crepitus at the neck joint and unstable movement including a positive "clunk test" (palpable subluxation). Lhermitte's sign may be elicited with head flexion. Imaging As many as 50\% of people with radiographic instability are actually asymptomatic. Initial radiography should include flexion and extension lateral X-rays in addition to static anterior/posterior and lateral views. These views are often repeated every 2–3 years, especially in patients with new symptoms or possibly requiring future intubation. Progression of disease is measured via anterior atlantodental interval (AADI), and posterior atlantodental interval (PADI). Other techniques include the Ranawat Index, MacGregor Line, the Clark stations, and the Redlund-Johnell measurement.
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