Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint)

TLDR

In 17 cases of irreducible atlanto‑axial rotatory subluxation, diagnosis was often delayed and patients presented with persistent torticollis, limited neck motion, and facial asymmetry. Diagnosis was made from plain radiographs and tomograms, confirmed by cineroentgenography, and treatment involved skull traction with optional atlanto‑axial arthrodesis. Among 13 patients undergoing arthrodesis, 11 had good outcomes, one fair, and one was lost to follow‑up; of the remaining four, one died during traction, two declined surgery, and one was not followed.

Abstract

In seventeen cases of irreducible atlanto-axial rotatory subluxation (here called fixation), the striking features were the delay in diagnosis and the persistent clinical and roentgenographic deformities. All patients had torticollis and restricted, often painful neck motion, and seven young patients with long-standing deformity had flattening on one side of the face. The diagnosis was suggested by the plain roentgenograms and tomograms and confirmed by persistence of the deformity as demonstrated by cineroentgenography. Treatment included skull traction, followed by atlanto-axial arthrodesis if necessary. Of the thirteen patients treated by atlanto-axial arthrodesis, eleven had good results, one had a fair result, and one had not been followed for long enough to determine the result. Of the remaining four patients, one treated conservatively had not been followed for long enough to evaluate the result, two declined surgery, and one died while in traction as the result of cord transection produced by further rotation of the atlas on the axis despite the traction.