Atlanto-axial rotary fixation: diagnosis by functional computed tomography

Moss, J. G.; Sellar, Robin; Bradnock, B.

doi:10.1259/0007-1285-62-740-755

Cited by 9 publications

(1 citation statement)

References 2 publications

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“…If conservative management with a collar is used, patients should be followed closely with dynamic cervical CT, for this condition can easily evolve into an irreducible lesion [26, 27, 28, 29]. Type I C1-2 rotatory fixation is very difficult to reduce, even with open surgery; and, in some cases, fusion must be performed without perfect reduction [27].…”

Section: Discussionmentioning

confidence: 99%

Pediatric Atlantoaxial Instability: Management with Screw Fixation

Wang¹,

Vokshoor²,

Stanley³

et al. 1999

Pediatr Neurosurg

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Sixteen pediatric patients (age range 3–15 years; mean 9.4 years) with atlantoaxial instability underwent screw fixation at Columbus Children’s Hospital between 1992 and 1998. Three patients with type II odontoid fractures underwent odontoid screw fixation. The remaining group of 13 patients had posterior C1-2 transarticular screw fixation and Sonntag C1-2 fusion. The group included 3 patients with rotatory C1-2 fixation, 4 patients with os odontoideum, 4 patients with congenital atlantoaxial instability and 2 patients with traumatic C1-2 instability. Postoperatively, all patients were placed in a Miami-J collar only. At 3 months follow-up, all patients achieved fusion. Bony fusion across the fracture line was clearly evident in patients with odontoid screws. The only complications in this series were a transient swallowing difficulty that resolved spontaneously in 2 weeks, and another patient’s C1-2 fusion had extended to C2-3 at 9 months follow-up. This study demonstrates that children at 3 years of age and older, who sustain a type II odontoid fracture with an intact transverse ligament, can be safely managed with odontoid screws if the fracture is less than 4 weeks old. Posterior C1-2 transarticular screw fixation can be done safely and results in a high fusion rate in children older than 4 years of age. The technical difficulties of screw fixation in children are discussed.

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Section: Discussionmentioning

confidence: 99%

Pediatric Atlantoaxial Instability: Management with Screw Fixation

Wang¹,

Vokshoor²,

Stanley³

et al. 1999

Pediatr Neurosurg

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Imaging of childhood torticollis due to atlanto-axial rotatory fixation

et al. 1995

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Atlanto-axial rotatory fixation is a rare cause of childhood torticollis. It may occur spontaneously or may be associated with trauma, upper respiratory tract infection or congenital abnormality of the cervical spine. Presentation is usually with persistent torticollis and "cock robin" deformity of the neck. In this paper the radiological experience in three patients is presented. Investigations included plain radiographs, plain anteroposterior tomography, CT and MRI. Displacement of the lateral mass of the atlas and the eccentric position of the odontoid peg can be seen in the plain films. CT scan can exclude fractures and confirm atlanto-axial rotation. The superimposition of CT images is demonstrated as a way of diagnosing subluxation. MRI offers better soft tissue differentiation and allows assessment of the integrity of the transverse ligament. This has an important bearing on the prognosis and may influence surgical treatment. It is important to recognise the plain film features of this uncommon condition and confirm the diagnosis with CT or MRI. The treatment options are discussed with particular reference to long term outcome.

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