Diagnosis of acute atlanto-axial rotatory fixation

Abstract

We report three cases of atlanto-axial rotatory fixation in adults. Early diagnosis was made by clinical tests showing restricted head rotation in maximal neck flexion and asymmetry of the transverse processes of the atlas, confirmed by cineradiography. Early treatment by traction may obviate long-term problems of torticollis and instability.

Traumatic Chronic Irreducible Atlantoaxial Rotatory Fixation in Adults: Review of the Literature, With Two New Examples

“…In 31 out of 56 cases, AARF was depicted and treated early on, 3,5,6,[8][9][10][11][12][13][14][15]17,18,[23][24][25][26][27][28][29][30][31][32][33][34][35]37 where in 25 instances, the diagnosis was made with significant delay. [4][5][6]11,16,[18][19][20][21][22]24,36 Hopefully, our review shows that only 25 out of 31 cases of the early diagnosed adults responded to traction and manipulation, whereas only 6 cases remained refractory to conservative measures.…”

“…In chronic cases, after achievement of a closed reduction in less severe traumas like in the case of a type I or type II AARF, in order to prevent a recurrence of subluxation, the external immobilization has been advocated. Most authors propose the use of a hard collar, 4,7,12,30,32,34 Minerva cast, 6 Minerva orthosis, 14,20 or halo vest 11,22,24 for the duration of 12 weeks. However, in more serious traumas (eg, a type II AARF with MRI-documented transverse ligament disruption, a type III or type IV AARF where stability is hampered after closed reduction), internal fixation by various modes would be solidly justified.…”

Neck Spasms in Children

“…Traditionally, the child's head is described as being in the "cock robin" position, named for the look a robin has while listening for a worm: head laterally flexed to one side, rotated to the opposite side, and with slight flexion. 4 With AARS, patients are often unable to return their heads to a neutral position. 4 And yet, despite kids' best attempts at internal decapitation, neurologic findings in AARS are rare, except for irritation to the greater occipital nerve as it emerges between C1 and C2.…”

“…4 With AARS, patients are often unable to return their heads to a neutral position. 4 And yet, despite kids' best attempts at internal decapitation, neurologic findings in AARS are rare, except for irritation to the greater occipital nerve as it emerges between C1 and C2. 4 Diagnosis can be made by radiograph or CT, but CT is the recommended imaging modality because management depends on the degree of subluxation (Figures 1 and 2).…”

General Description of Pediatric Acute Wryneck Condition

“…The appearance of computer tomography in the 70-s of the century allowed researchers to define the details of atlas displacement more accurately [34][35][36] At present dynamic and 3-D CT are mainly used [37]. Li et Pang (1995) have developed the criteria of 3-D dynamic CT using to define the diagnosis more exactly and develop the tactics for treating the atlantoaxial fixation [38].…”