Atlanto-axial Chronic Rotational Subluxation

Abstract

Introduction Atlanto-axial rotational subluxation, a relatively common condition in pediatric patients, is normally secondary to traumatic inflammatory processes and is favored by the great degree of cervical mobility in children. If untreated, the condition may become chronic and result in a fixed cervical deformity whose diagnosis and treatment may pose a significant challenge. Only a few series have been published, all of them containing a small number of cases and there is an absence of definite criteria for the diagnosis and treatment of this condition. Clinical cases Three cases are presented of atlanto-axial chronic rotational subluxation treated over a 15-year period. Ages at presentation were 9.7 and 16 year. In all patients, the same protocols, both diagnostic (x-rays, CT-scan and MRi in one case) and therapeutic (gradual halo traction until reduction was confirmed by a CT-scan and halo cast immobilization) were used. In one case full reduction was not achieved and, consequently, a C1-C2 posterior arthrodesis was performed. Results All three patients had a minimum follow-up of 2 years. Patients not subjected to arthrodesis showed a satisfactory clinical situation and normal cervical motion; the remaining patient had slight torticollis with somewhat limited cervical rotation. There have been no relapses. Conclusions Atlanto-axial chronic rotational subluxation is a condition with severe and painful repercussions for the patient and whose management poses serious challenges. In our series, all cases were treated following the same protocol: progressive cranial traction and halo cast immobilization. Complete reduction was achieved, while in the remaining one the reduction achieved was only partial, which made it necessary to perform a C1-C2 posterior arthrodesis. As the literature does not provide hard-and-fast treatment criteria, we suggest possible protocols for action.