Adult Case of Atlantoaxial Rotatory Fixation Treated with In Situ Fixation Using an Unusual Posterior Instrumentation Construct

Abstract

Atlantoaxial rotatory fixation (AARF) occurs commonly in children who have undergone trauma. It is usually corrected with conservative therapy. In this report, however, the patient was an adult with AARF who was treated surgically. A 64-year-old woman presented with a 1-year history of spastic gait and hand clumsiness. Imaging studies revealed the presence of AARF, os odontoideum, and severe spinal cord compression at that spinal level. As the AARF had not been responded to head traction with a halo device, we decided to treat the patient with in situ posterior fixation. Because the rigid dislocation was present between the atlas and the axis, we were forced to make an unusual instrumentation construct. Neurological symptoms other than hand numbness diminished after the surgery, and arthrodesis was obtained between the occiput and the axis. It should be noted that surgical planning for posterior instrumentation construct is required when rigid AARF is treated surgically.

Surgical Management of Adult Traumatic Atlantoaxial Rotatory Subluxation with Unilateral Locked Facet; Case Report and Literature Review

“…Nonetheless, regarding the etiology of intense trauma in most adult cases of traumatic AARS likelihood of more severe or fatal types, although still rare, are higher as compared to pediatric cases [ 7 , 9 ]. The typical clinical presentation includes cervical pain with torticollis and contralateral neck bending, known as Cock-Robin position [ 8 , 12 , 14 ]. Although some atypical accompanying clinical feature has also been reported [ 5 ].…”

“…The delay in diagnosis and management might result in neurological deficit or respiratory suppression and death due to upper cervical cord injury [ 10 , 11 ]. The treatment of this condition is controversial and both conservative and surgical treatment have been described previously [ 12 - 14 ]. The rarity of the AARS in adults, has limited our experience in both diagnosis and management of the condition.…”