A diagnose not to miss: Rotatory Atlantoaxial subluxation in emergency service

Abstract

SUMMARY Objective: The objective of this study is to take attention to atlantoaxial subluxations especially in pediatric population that may be misdiagnosed in the emergency services easily. When diagnosed early in the emergency services, it may be corrected with ease and the treatment is more likely to be conservative. Method: Seven patients with atlantoaxial rotatory subluxation (AARS), between ages of 5 and 13, who admitted to our emergency service between 1 July 2013 - 1 September 2014 were examined retrospectively. Results: All patients were treated conservatively with bed rest, muscle relaxants and rigid cervical collar. None of them needed surgery. Conclusions: Atlantoaxial rotatory subluxation (AARS) is one of the main types of cervical spine anomalies seen in pediatric patients and is a rare condition that is often misdiagnosed and therefore incorrectly managed especially in emergency services. The diagnosis requires a high index of suspicion. Many pediatric cervical spine injuries can be treated with external immobilization and AARS is almost always reducible. Pediatric population is prone to upper spine injuries due to ligamentous laxity and AARS should always be kept in mind especially in emergency services. Key words: Atlantoaxial subluxation , torticollis , diagnosis, emergency service OZET Amac: Bu calismanin amaci, acil servislerde ozellikle pediyatrik populasyonda kolaylikla yanlis tani alabilecek atlantoaksiyel subluksasyonlara dikkat cekmektir. Acil servislerde erken tani konuldugunda; kolaylikla duzeltilebilir ve konservatif tedavi ihtimali daha yuksektir. Yontem: Acil servisimize 1 Temmuz 2013-1 Eylul 2014 arasinda basvuran; 5 ve 13 yaslari arasinda atlantoaksiyel rotatuvar subluksasyonlu (AARS) 7 hasta retrospektif olarak incelendi. Bulgular: Tum hastalar yatak istirahati, kas gevsetici ve sert boyunluk ile konservatif olarak tedavi edildi. Hicbirinde cerrahi ihtiyaci olmadi. Sonuc: Atlaktoaksiyel rotatuvar subluksasyon (AARS) pediyatrik hastalarda gorulen baslica servikal omurga anomali tiplerinden biridir ve siklikla yanlis tani konulan nadir bir durumdur; bu nedenle ozellikle acil servislerde yanlis yonetilebilmektedir. Tani icin yuksek oranda suphe duymak gerekmektedir. Pekcok pediyatrik servikal omurga yaralanmasi eksternal immobilizasyon ile tedavi edilebilir ve AARS hemen daima redukte edilebilirdir. Pediyatrik populasyon ligamentoz laksite nedeni ile ust omurga yaralanmalarina meyillidir ve AARS ozellikle acil servislerde her zaman akilda tutulmalidir. Anahtar Kelimeler: atlantoaksiyel subluksasyon, tortikollis, tani, acil servis.