Atlantoaxial Rotatory Subluxation in a 10-Year-Old Boy

Abstract

<jats:p> Atlantoaxial rotatory subluxation (AARS) is the loss of normal alignment and stability of the first (atlas) and second (axis) cervical vertebrae with respect to each other. We describe the clinical challenges of managing a 10-year-old boy who presented with repetitive episodes of torticollis. Open-mouth odontoid radiograph and computed tomographic (CT) scan gave a diagnosis in ARRS, based on its characteristic imaging findings. The child was admitted multiple times for continuous halter traction in the first 6 months after symptom onset. He also experienced a temporary complication from an overcorrection with correcting neck bracing. Seven months after symptom onset, this case was discussed by a multidisciplinary spine team and referred to chiropractic clinic. Despite persistent radiographic evidence of atlantoaxial instability, after 5 months of chiropractic treatment, the child was asymptomatic with nearly full range of neck movement. He also weaned off acetaminophen he had been taking over the past year. Incidentally, bilateral gynecomastia was discovered at the surveillance after treatment. The incidental finding of innocent gynecomastia, even if common in preteen boys, brings up the topic of acetaminophen’s effects on the regulation of sex hormones that was previously overlooked. </jats:p>

Cervicogenic Dizziness in an 11-Year-Old Girl: A Case Report

“…As there is an increasing use of smartphones, the immature growing cervical spine is more prone to kyphotic deformity due to children having a relatively large head, higher ligamentous laxity, immature paraspinal muscles, shallow facet joints, high water content in the disks, unfused epiphyses, and wedging of vertebrae. 10 , 23 The fulcrum for flexion in the cervical spine in children is at the C2/C3 level and descends to C5/C6 as they grow. 18 In this context, it is possible to misinterpret these physiologic variants, such as loss of cervical lordosis, wedging or anterior displacement of the vertebrae, as a pathological ramification.…”

“…The immature growing cervical spine has unique anatomic, physiologic and biomechanical features, such as higher ligamentous laxity, malleable features of the vertebra and more horizontal orientation of the facet complex. 10 Prolonged, excessive neck flexion may predispose children to physical health problems, such as musculoskeletal neck pain, 11 cervical disc degeneration, 12 and cervical kyphosis. 13 The current study serves as a vivid example of identifying CGD and aims to raise awareness of the potential harms of excessive smartphone use by children.…”

Dystonic Tremor as an Atypical Presentation of Cervical Radiculopathy

“…The restoration of autonomic nervous function can be achieved following successful cervical rehabilitation [12]. The response to chiropractic treatment, however, exemplifies the potential benefits of conservative management of cervical dystonia [13][14][15]. Daily cervical manipulative therapy, followed by a combination of reduced-frequency therapy and mechanical spinal decompression, resulted in the complete and sustained resolution of his symptoms.…”

Multimodal Management of Coexisting Atlantoaxial Subluxation and Spinal Stenosis in an Older Adult: A Case Report and Literature Review

“…Notably, various permutations of the following phrases were utilized: "chiropractor," "atlantoaxial subluxation," "atlantoaxial dislocation," and "atlantoaxial instability." We searched and found seven cases (Table 1) [2,[7][8][9][10][11][12]. The total number of patients under consideration, including the present case, amounted to eight, with a mean age of 55±41; 75% of the patients identified as female.…”