Does alar ligament injury predict conservative treatment failure of atlantoaxial rotatory subluxation in adults: Case report and review of the literature

Ng, Christina; Dominguez, Jose F.; Feldstein, Eric; Houten, John K.; Spirollari, Eris; Gandhi, Chirag D.; Cole, Chad; Kinon, Merritt D.

doi:10.1038/s41394-021-00464-9

Cited by 4 publications

(3 citation statements)

References 46 publications

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“…The main goal of treatment is to relieve pain, restore spinal stability, and prevent the development of neurological deficits. The decision to adopt a surgical approach is taken based on the stability of the joint, its relocation, and the involvement of the transverse alar ligaments [ 20 , 21 ]. For cases of AARD with spinal instability, neurological involvement, or the inability to achieve or sustain reduction through conservative methods, a surgical approach is recommended [ 5 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Irreducible AcuteTraumatic Atlantoaxial Rotatory Subluxation in an Adult

Alhasani¹,

Obeidat²,

ALMohammed³

et al. 2022

Cureus

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Traumatic atlantoaxial rotatory subluxation (AARS) is a condition that is extremely rare in adults when compared to the pediatric population. The most common symptoms of this condition are torticollis and post-traumatic neck pain. Our patient is a 41-year-old male who presented to the emergency room within hours of the injury. He came by himself with his relative as a case of road traffic accident. He was the first passenger and had been restrained during the car accident, with no ejection or rollover. He presented with stiffness/pain and reduced range of motion in the neck. Computed tomography (CT) of the cervical spine showed rotatory subluxation of C1 over the C2 with a locked facet. Within 24 hours of the RTA and patient admission, we attempted cervical traction. The reduction was not successful. So, we decided to reduce AARS through a surgical approach. The patient was taken to the operating room for open reduction and fixation using the Harms technique for C1-C2 fusion. The patient recovered from the surgery uneventfully, without any complications, recovered cervical mobility, and improved torticollis. Surgical management through open reduction and internal fixation is recommended for AARD cases in which close reduction fails due to a locked facet.

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Irreducible AcuteTraumatic Atlantoaxial Rotatory Subluxation in an Adult

Alhasani¹,

Obeidat²,

ALMohammed³

et al. 2022

Cureus

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“…Type I consists of a unilateral anterior rotation of an atlas mass that pivots around the odontoid while maintaining the integrity of the transverse ligament of the atlas [ 20 , 21 , 22 ]. As indicated by Ng et al [ 23 ], rupture of the alar ligament may be a negative prognostic indicator for the success of non-surgical treatment of type I atlantoaxial rotator subluxation. Type II, in which there is also a unilateral anterior displacement of an atlas mass, is performed pivoting on the contralateral atloaxoid joint resulting in an atloaxoid separation of up to 5 mm.…”

Section: Etiologymentioning

confidence: 99%

“…The primary goal of treatment in patients with non-traumatic rotatory subluxation of C1 over C2 (SRAA) is to relieve pain and prevent the development of neurological deficits. The decision to adopt a surgical approach is based on the stability of the joint, its relocation, and the involvement of the transverse alar ligaments [ 23 , 35 ]. It should be noted that in untreated cases pathological adhesion may occur between C1 and C2, which increases with the persistence of abnormal dynamics, probably due to contracture of the periarticular soft tissues and chronic adhesive changes on the articular surfaces [ 36 ].…”

Section: Treatmentmentioning

confidence: 99%

C1-C2 Rotatory Subluxation in Adults “A Narrative Review”

González

Aragón

Sanjuan³

et al. 2022

Diagnostics

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The atlantoaxial joint C2 (axis) with the anterior arch of C1 (atlas) allows 50% of cervical lateral rotation. It is responsible for precise and important movements that allow us to perform precise actions, both in normal and working life. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed and the outcome is worse. An early diagnosis and treatment are essential to ensure satisfactory neurological and functional outcomes. The aim of this review is to analyze C1-C2 rotatory subluxation in adults, given its rarity. The time between injury and reduction is key, as it is directly related to prognosis and the severity of the treatment options. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed as a lot of cases are not related to a clear trauma, with a poor prognosis just because of the late diagnosis and the outcome is worse. The correct approach and treatment of atlantoaxial dislocation requires a careful study of the radiological findings to decide the direction and plane of the dislocation, and the search for associated skeletal anomalies.

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