J Korean Neurotraumatol Soc.  2010 Jun;6(1):70-73. 10.13004/jknts.2010.6.1.70.

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

• Lim CH
• Lee MS
• Rim BC
• Min KS
• Kim YG
• Kim DH

• KMID: 2192373
• DOI: http://doi.org/10.13004/jknts.2010.6.1.70

Abstract

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.

Keyword

Atlanotaxial subluxation; Rotatory fixation; Conservative management

MeSH Terms

Accidents, Traffic
Adult
Axis, Cervical Vertebra
Child
Diagnostic Errors
Head
Humans
Lip
Mouth
Neck Pain
Surgical Procedures, Operative

Figure

• 

  FIGURE 1 Cervical spine radiography (A) and the diagram (B) showing a abnormal position of the dens axis. A: Cervical spine open mouth radiography showed the left C1 lateral mass which is closer to the odontoid process than right one. B: Diagram of the atlas was rotated to the right compared to the axis.

• 

  FIGURE 2 Pre-reduction radiologic examination. A: Three-dimensional surface reconstructions of CT showed the atlas was rotated to right side and the anterior lip of left superior facet of C2 vertebra and left transverse process of C2 vertebra was fractured. B: Cervical spine CT revealed the atlas was rotated to the right compared to the axis. C: Cervical spine MRI revealed no evidence of cord injury.

• 

  FIGURE 3 Post-reduction radiologic examination. A: Post-reduction cervical spine open mouth radiography shows successful reduction of cervical spine. B: Follow up three-dimensional surface reconstructions of CT shows successful reduction of cervical spine (three month later). C: Follow up cervical spine CT revealed the atlas and axis has been completely corrected (three month later).

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