Rotary Fixation of the Atlantoaxial Joint: Rotational Atlantoaxial Subluxation

Wortzman, G; Dewar, F. P.

doi:10.1148/90.3.479

Cited by 133 publications

(52 citation statements)

References 17 publications

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“…However, in addition, we report that 36°o f rotation correlates with a very wide contact loss of the corresponding facets of C1 and C2 (80%, far more than was supposed). This normal contact loss, shall we call "facet stripping", is actually unknown and does not correspond to the one shown by White and Panjabi in their book when explaining C1-C2 rotation by means of an "over the top" view [31].…”

Section: Discussionmentioning

confidence: 89%

“…The mechanism that causes this -shall we call "situation" -is not fully understood and may possibly be secondary to simple muscle spasm. This "situation" has appeared in specialized literature as rotary or rotatory dislocation or deformity [6], rotational subluxation [15,31], rotary fixation and spontaneous hyperemic dislocation [28]. Fielding and Hawkins [8] preferred the term atlanto-axial rotatory fixation, since the fixation of the atlas on the axis may occur with subluxation, dislocation or when the relative position of the atlas and axis is still within the normal range of rotation, without specifying this point.…”

Section: Discussionmentioning

confidence: 99%

“…Cervical rotation resulting from patient attitude in the case of Grisel's syndrome or other clinical conditions can cause radiographic changes that are indistinguishable from rotary atlanto-axial subluxation [8,19,20,30]. Open-mouth radiographs of the upper cervical spine can be made by having the patient rotate their head to each side [15,31], but they are also difficult to interpret [8,15]. Unfortunately, a patient's lack of co-operation or diminished active motion of the neck may prevent these special radiological studies [5,7,22].…”

Section: Discussionmentioning

confidence: 99%

“…The main value of their paper was imaging an axial view from a transoral and lateral cineradiography. Wortzman and Dewar [31] had previously proposed a parallel term, in which rotary fixation and subluxation were not that well differentiated and they correlated with Fielding and Hawkins' grade 1. Today, the vast majority of radiologists and cervical spine surgeons have very little clinical experience of C1-C2 rotational instability.…”

Section: Introductionmentioning

confidence: 99%

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Preliminary CT study of C1-C2 rotational mobility in normal subjects

Villas

Arriagada

1999

European Spine Journal

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IntroductionOnly in neutral position is the caudal surface of the atlas (C1) articular processes in full contact with its corresponding opposite in the axis (C2). Therefore, any rotational displacement of C1 on C2 should result in some degree of contact loss between the corresponding articular surfaces.The classical concepts about atlanto-axial (C1-C2) mechanics give a 40°rotation to both the left and right [29,30], so we can expect that a normal full rotation implies a wide articular surface contact loss. Nevertheless, not only is there no image representing this "expected fact" in classical literature, but it is simply indicated by means of circular arrows [30] upon an anatomical schematic model representing a lateral view of C1 on C2 in neutral position. White and Panjabi [30] show a contact loss between the opposing surfaces of the C1 and C2 articular processes (with no mention of it) when trying to demonstrate the possibly troublesome lengthening that the vertebral artery undergoes when nearing its rotational limits. Furthermore, we have also found a paper showing images in which the previously mentioned surface contact loss can be seen when explaining another altogether different topic [16].The paper by Fielding and Hawkins [8, 9] on atlantoaxial rotatory fixation has become a classic one and it is constantly referred to in almost all published papers relatAbstract A CT study of normal atlanto-axial (C1-C2) rotary mobility was carried out on ten normal immature subjects. In order to determine the limits of normality, the ten children underwent clinical and radiological examination. The clinical study included checking for objective signs of joint laxity and measurement of rotational neck mobility. The radiological study included standard lateral radiographs in neutral and maximal flexion positions and a CT scan taken in maximal left and right side rotation at the C1-C2 articular processes joint. The superpositioning of the images taken in every rotational direction showed, in all ten children, a wide contact loss between the C1-C2 corresponding facets, ranging from 74 to 85% of the total articular surface. The report on these images, carried out by three independent radiologists, concluded that there was a rotary subluxation in all cases. In the ten children studied, there were no significant differences with regard to neck mobility or laxity signs in clinical or standard X-ray examination. Our results lead us to conclude that, except for complete C1-C2 rotational dislocation with facet interlocking, a CT scan showing a wide -but incomplete -rotational facet displacement is not sufficient to define a status of subluxation. This leads us to perceive that there is a risk of overdiagnosis when evaluating upper cervical spine rotational problems in children. The concept of both rotary C1-C2 fixation and subluxation should be revised.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preliminary CT study of C1-C2 rotational mobility in normal subjects

Villas

Arriagada

1999

European Spine Journal

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“…The pathophysiology of these lesions are not well defined. 4) Wortzman and Dewar 17) concluded that the rotational fixation is not due to a fracture or ligamentous rupture but to damage of an unknown nature at the atlanto-axial joint itself. At the same time, they noted that the most believable theory is a tear and invagination of capsular ligaments the atlanto-axial synovial joints.…”

Section: Discussionmentioning

confidence: 99%

The Atlanto-Axial Rotatory Fixation in Adult Treated by Non-Surgical Approach

Lim

Lee

Rim

et al. 2010

J Korean Neurotraumatol Soc

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The atlanto-axial rotatory fixation (AARF) is a rare clinical condition that occurs more commonly in children than in adults. It is easy to misdiagnosis AARF because of peculiar feature of atlanto-axial articulation. The authors reported a case of AARF in an adult who was treated by im-mobilization without surgery. Due to a traffic accident, the patient's head was forcefully rotated to the right side and flexed to the left side. The patient had no neurological deficit, but the patient's head was fixed in a position rotated to the right and tilted to the left. In open mouth view and three dimensional CT reconstruction images the atlas was rotated to the right side and the anterior lip of left superior facet and left transverse process of axis were fractured. The patient underwent intermittent Halter-traction for seven days. After the Halter-traction, we gained successful reduction and posterior neck pain was subsided. After the reduction, Halo-vest was applied for three months and the patient recovered well without any neurological deficits. In some case of adult traumatic AARF patient, closed reduction and Halo-vast external fixation may be successful instead of open reduction and fixation. And if it is successful, we can avoid operative procedure. ( J Kor Neurotraumatol Soc 2010;6:70-73 ) KEY WORDS: Atlanotaxial subluxation·Rotatory fixation·Conservative management.

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What is it? Case 1, 1988. Head tilt in a young girl associated with neck pain and limitation of neck movement

1988

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HistoryThis 7-year-old girl had been well until she awoke with right posterior neck pain and a head tilt to her right shoulder. She had no recent infections, had not received any medications, and did not have a history of head or neck trauma. Her pediatrician prescribed amoxicillin and Dimetapp for serous otitis media on the right side, but the pain and head tilt persisted. Cervical spine X-ray films were normal.She was hospitalized 1 month after the onset of her symptoms and was treated symptomatically with traction and a cervical collar, Valium, and aspirin, without relief. A bone scan and computed tomography (CT) scan of her head and neck (not available to us) were normal and results of a mono spot were negative. Past medical history was significant for recurrent otitis media and myringotomies at age 1 year. Family history was unremarkable.When seen at the Neurological Institute of New York 2 months after onset of her symptoms, the examination was significant for generalized neck discomfort and focal pain localized immediately below the right mastoid region in the vicinity of the upper sternocleidomastoid muscle. Light palpation in this region resulted in increased discomfort and crying. There was firmness of the soft tissues, mild spasm of the sternocleidomastoid muscle, and shoddy matted lymph nodes in the posterior cervical chain. She preferred to wear a cervical collar and when the Case report and videotape were submitted by Heide Shale and Stanley Fahn. 347

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Rotary Fixation of the Atlantoaxial Joint: Rotational Atlantoaxial Subluxation

Cited by 133 publications

References 17 publications

Preliminary CT study of C1-C2 rotational mobility in normal subjects

Preliminary CT study of C1-C2 rotational mobility in normal subjects

The Atlanto-Axial Rotatory Fixation in Adult Treated by Non-Surgical Approach

What is it? Case 1, 1988. Head tilt in a young girl associated with neck pain and limitation of neck movement

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