Imaging of childhood torticollis due to atlanto-axial rotatory fixation

Abstract

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.

The Treatment of Traumatic Atlantoaxial Rotatory Subluxation (Fielding Type I) and the Correlation between the Clinical Progress and Radiological Reduction Parameter

“…CT scan minimizes these problems but it has its own limitations. 3,6) The author also experienced difficulties to reach a correct diagnosis with X-ray due to the patients' abnormal postures in many cases and 3D CT provided accurate diagnostic image of atlantoaxial relation in these cases.…”

“…2,3) There are a number of studies about pediatric atlantoaxial rotatory subluxation from type 1 to type 4 (Fielding classification) to date. The causes for this are known to be the genetic disorders and mild injuries such as upper respiratory tract infection, head and neck operation, Down syndrome and Morquio's syndrome.…”

“…The causes for this are known to be the genetic disorders and mild injuries such as upper respiratory tract infection, head and neck operation, Down syndrome and Morquio's syndrome. 3,4) On the other hand the cause of atlantoaxial rotatory subluxation of patient older than 20 years old is thought to be due to severe trauma 5) and much discussion about this haven't been taken placed apart from only several case reports. Therefore, the continuous studies regarding whether applying established management methods of pediatric atlantoaxial rotatory subluxation to the adult traumatic atlantoaxial rotatory subluxation is required.…”

Atlantoaxial Rotatory Fixation

“…2 In true AARF, the head and neck deformity is not caused by primary overactivity of the sternomastoid, but rather by pathological stickiness within the C1-C2 joints, which induces secondary or reflexic sternomastoid spasm on the side of the chin, as if the muscle is attempting to correct (rather t h a n c a u s e ) t h e d e f o rmity. 6,31,41,43,44 There is also tension in the posterior nuchal muscles. The child often has intense pain in the neck and jaw, keenly resists any touching by the examiner, and enacts a drama seldom encountered with muscular torticollis.…”

General Description of Pediatric Acute Wryneck Condition

“…Some authors believe that the sign of asymmetric axis odontoid process location relative to atlas lateral masses is quite sufficient to make the diagnosis [26,27]. Others have doubts about the reliability of the most x-ray signs observed connecting them with the inability to achieve proper positioning in the process of x-ray study [28,29] or consider them as a variant of the norm [30].…”