Atlantoaxial Rotatory Fixation

Abstract

Thus, children with painful torticollis should undergo the 3-position CT protocol not only to confirm the diagnosis of AARF but also to grade its severity. Closed reduction with traction should be instituted immediately to avoid the serious consequences of chronicity. Proper typing and reckoning of the pretreatment delay are requisites for selecting treatment modalities. Recurrent dislocation and incomplete reduction should be treated with posterior C1-C2 fusion in the best achievable alignment.

Anterior Retropharyngeal Reduction and Sequential Posterior Fusion for Atlantoaxial Rotatory Fixation With Locked C1–C2 Lateral Facet

“…Hence, early diagnosis and treatment could reduce the risk of severe damage. 2,4,7,15 On radiographs, however, the abnormal head position and other deformities might cause overlap of adjacent bone structures, increasing diagnostic difficulty, even causing a misdiagnosis. Such misdiagnosis might prolong the course of the disease, which would transform into chronic AARF.…”

“…9,16,19 Other authors, however, stated that surgery should be contemplated if the duration of symptoms was more than 1 month. 7,12,15,16 Phillips and Hensinger 19 reported that if the AARF was diagnosed within 1 month of onset, cervical traction in combination with muscle relaxants and analgesia provided a good prognosis for recovery. Fernandez Cornejo et al 25 reported that the risk of recurrence or permanent deformity became higher if the duration between the onset of torticollis and reduction was longer than 3 weeks, even after treatment, because of the development of chronic changes in the transverse and alar ligaments.…”

“…We speculated that a deformed C1-C2 lateral facet osseous union with adherent inflamed synovial fringes and ligamentous and capsular contractures increased the surgical difficulty. Hence, AARF with a locked C1-C2 lateral facet should draw more attention and be treated earlier as Pang et al 7 …”

“…Threedimensional computed tomographic (3D CT) reconstruction scans can be used to confirm the diagnosis. [3][4][5][6][7] Although the pathogenesis is still not well defined, the most common causes are trauma and inflammation. 8,9 The morbidity associated with AARF is generally minimal although relatively common in children because of the immature anatomical structure.…”

Trauma of the upper cervical spine: focus on vertical atlantoaxial dislocation

“…A few cases have been associated with other superior cervical spine fractures [17][18][19][20]. It must be noted that pure anterior [6], vertical, or lateral [10] AAD is more likely to occur in odontoid pseudarthrosis or malformation or rheumatoid arthritis, and rotatory AAD in children [21].…”