Traumatic atlantoaxial rotatory fixation in an adult patient

Abstract

The purpose of this paper is to show a case of a young woman with a posttraumatic AARF successfully treated conservatively. This case delineates the difficulties in diagnosing this pathology, as well as the challenges encountered in its management.

A Case of Pseudodystonia in a Patient on Neuroleptics

“…Neuroleptic‐induced tardive dystonia is unlikely since no positive effect was achieved despite neuroleptic withdrawal and repeated botulinum toxin injections under electromyographic control. Also, a clinical examination found a typical “cock robin” position, suggesting AARF; therefore, a cervical CT scan with bone reconstruction was performed showing a fusion in rotation of the atlantoaxial joint by an ossified membrane (Fig. ).…”

“…The pathophysiology of atlantoaxial rotatory subluxation/fixation is not fully understood. Evidence from cadaveric dissection and imaging studies suggest that the pathologic mechanism by which rotatory dislocation occurs is through disruption of the facet capsule followed by alar ligament disruption . In the case reported by Watanabe et al, repeated rotation due to head tremor caused friction of the lateral atlantoaxial facet and led to soft tissue hypertrophy, giving it a pseudotumor aspect .…”

Expert’s comment concerning Grand Rounds case entitled “Traumatic atlantoaxial rotatory fixation in an adult patient” by MA García-Pallero, et al. (Eur Spine J, 2017; DOI 10.1007/s00586-016-4916-3)

“…This interesting paper and literature review outline a rare cervical condition in adults of bilateral atlantoaxial rotational fixation (AARF) [1]. Importantly, AARF can present to most spinal practitioners, irrespective of a surgical or conservative training or learning, as a common biomechanical condition, post-traffic accident torticollis.…”

“…AARF in adults is, however, extremely rare, and the English medical literature describes very few cases [1].…”

“…This Grand Round's paper [1] describes the severe upper cervical injury of AARF after a traffic incident in a 28-yearold female. Although the patient sought immediate treatment at A&E, the AARF was only correctly diagnosed, after appropriate assessment, 1 week after the accident.…”