J Korean Soc Spine Surg.  2011 Dec;18(4):202-207. 10.4184/jkss.2011.18.4.202.

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

• Kim SW
• Ahn YJ
• Yang BK
• Yi SR
• Kim SJ

• KMID: 1447997
• DOI: http://doi.org/10.4184/jkss.2011.18.4.202

Abstract

STUDY DESIGN: This is a retrospective study.
OBJECTIVES
We will discuss clinical outcomes of adult traumatic atlantoaxial rotatory subluxation (Fielding type I) and verify the correlation between the clinical outcomes and radiological reduction rate. SUMMARY OF LITERATURE REVIEW: Atlantoaxial rotatory subluxation which usually occur in children by non-traumatic sources or minor trauma has been discussed persistently. However, studies of atlantoaxial rotatory subluxation which occur in adults over 20 years old, especially by traumatic injury is rare.
MATERIALS AND METHODS
From October 2004 to April 2011, thirty patients diagnosed of traumatic atlantoaxial rotatory subluxation with 6 months follow-up period were enrolled in the study. After diagnosis, we started treating Halter traction with 5 lbs. We discontinued traction when the patient recovered over 90% of ROM and applied Philadelphia collar to the patient. We measured visual analogue scale (VAS) for cervical pain and ROM. We measured atlanto-dens interval (ADI) and lateral mass-dens interval (LDI) difference using three-dimensional computed tomography (3D-CT) to validate radiological reduction rate.
RESULTS
At the end of follow-up, none of the patients complained over pain and all recovered to full ROM. ADI was in normal range during the whole treatment period. LDI difference gradually decreased during treatment period, however, only 8 cases (26.7%) came back to normal range.
CONCLUSIONS
In traumatic atlantoaxial rotatory subluxation (Fielding type I), satisfactory clinical outcomes such as pain relief or ROM improvement using traction and the radiological reduction rate was also improved but it failed to achieve a complete reduction of LDI difference in radiography.

Keyword

Adult; Atlantoaxial subluxation; Fielding type I; three dimensional computed tomography

MeSH Terms

Adult
Child
Follow-Up Studies
Humans
Neck Pain
Philadelphia
Porphyrins
Reference Values
Retrospective Studies
Traction
Porphyrins

Figure

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  Fig. 1. The following 3D-CT coronal images are in the order as following; (A) initial, (B) pain relief, (C) full ROM recovery and (D) 2 weeks, (E) 4 weeks, (F) 8 weeks after applying a brace. Lateral mass-Dens Interval (LDI) difference is calculated by subtracting b from a.

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  Fig. 2. The following graph shows Lateral mass-Dens Interval(LDI) difference at diagnosing point, 2 weeks, 4 weeks, 8 weeks after applying a brace.

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