Traumatic atlantoaxial rotatory subluxation in an adolescent: a case report

Escobar, Luis Enrique Meza; Osterhoff, Georg; Ossendorf, Christian; Wanner, Guido A.; Simmen, Hans‐Peter; Werner, Clément M. L.

doi:10.1186/1752-1947-6-27

Cited by 14 publications

(8 citation statements)

References 17 publications

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“…It was first described by Bell in 1930 and classified by Fielding and Hawkins in 1977 into four types according to the severity of displacement and the anterior or posterior position of the atlas in relation to the axis [1]. This condition has also been reported in patients following otorhinolaryngological or head and neck surgeries, and patients with disorders such as rheumatoid arthritis, Down syndrome, and Morquio syndrome [2][3][4][5][6]. To the best of our knowledge, this is the first case of AARF related to postoperative complications following neurosurgery.…”

Section: Introductionmentioning

confidence: 99%

Posterior C1-C2 Fusion for Atlantoaxial Rotatory Fixation After Posterior Fossa Craniotomy in a 4-Year-Old: A Case Report

Benites¹,

Cavalheiro²

2019

Preprint

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Study Design: Case report Objective: This study aimed to highlight that Atlantoaxial rotatory fixation (AARF) can be related to neurosurgery procedures in children with an afterwards demonstration of good results after halo-gravity traction and C1-C2 stabilization using the Harms technique. Summary of Background Data: AARF is characterized by dislocation or subluxation of the atlantoaxial joint, leading to a rotational deformity which may cause pain. Such a condition is mostly found in pediatric patients. Trauma, upper respiratory infections, surgery of the head and the neck, and even rheumatoid arthritis and Down syndrome have been designated as predisposing factors. It is important to note that in some cases AARF evolves with no apparent cause and to date, the choice of optimal surgical procedure should be carefully selected, considering the anatomical and bone conditions, as well as the surgeon’s experience with each technique. Methods: We report the first case related, in our knowledge, of a 4-year-old boy who presented atlantoaxial rotatory fixation after a posterior fossa craniotomy to treat a cerebellar astrocytoma. Results: At our medical facility, we diagnosed AARF by plain radiograph and CT image, and he was treated with continuous cranial traction for 14 days. Initially, we detected that he had no C1 posterior arch or C2 spinous process, so our choice was to perform Harms technique. Postoperatively, the patient was placed in a cervical collar for four weeks. At him 4-years postoperative follow-up, he was doing well and did not develop any complication. Conclusion: We call the attention to the fact of AARF can be developed after neurosurgical procedures. A surgical technique to be used in Atlantoaxial subluxation should be carefully select. In our case, Harms technique after cranial traction was an excellent option to correct and stabilize the abnormal neck position presented. However, further studies are required to determine the best technique to be used in the pediatric population.

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Section: Introductionmentioning

confidence: 99%

Posterior C1-C2 Fusion for Atlantoaxial Rotatory Fixation After Posterior Fossa Craniotomy in a 4-Year-Old: A Case Report

Benites¹,

Cavalheiro²

2019

Preprint

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“…In adults, AARF is rarely caused by trauma and can usually be corrected by traction using a halo device. 5 , 6) Owing to the rarity of adult cases, however, there are few descriptions of the operative method for AARF. We describe an adult case of AARF with os odontoideum who was treated by C1 laminectomy and in situ occiput–C2 fixation.…”

Section: Introductionmentioning

confidence: 99%

Adult Case of Atlantoaxial Rotatory Fixation Treated with In Situ Fixation Using an Unusual Posterior Instrumentation Construct

Miyao

Sasaki

Umegaki

et al. 2017

NMC Case Report Journal

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Atlantoaxial rotatory fixation (AARF) occurs commonly in children who have undergone trauma. It is usually corrected with conservative therapy. In this report, however, the patient was an adult with AARF who was treated surgically. A 64-year-old woman presented with a 1-year history of spastic gait and hand clumsiness. Imaging studies revealed the presence of AARF, os odontoideum, and severe spinal cord compression at that spinal level. As the AARF had not been responded to head traction with a halo device, we decided to treat the patient with in situ posterior fixation. Because the rigid dislocation was present between the atlas and the axis, we were forced to make an unusual instrumentation construct. Neurological symptoms other than hand numbness diminished after the surgery, and arthrodesis was obtained between the occiput and the axis. It should be noted that surgical planning for posterior instrumentation construct is required when rigid AARF is treated surgically.

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“…(1-5) This prevalence occurs because of specific anatomic characteristics of childhood, such as disproportion between head-neck, underdeveloped cervical musculature, laxity of the joint capsule, ligament elasticity and horizontal shape of the articular facets between atlas and axis vertebrae. (3-7) This condition can occur due to inflammation/infection (2,6,7) or trauma, (1,2,4,6) or because of neurogenic or idiopathic origin. (2) …”

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confidence: 99%

“…(1,6,7) Images of tridimensional reconstruction provides a global visualization of rotation, therefore helping to establish the diagnosis. (2,3,7) In addition, the magnetic resonance image can also be requested to evaluate the risk of vascular-nervous bundle compromising and injuries of the ligaments adjacent to vertebrae. (1,5-7) …”

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confidence: 99%