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Katsuyama Y, Okuda Y, Kanamura H, Sasaki K, Saito T, Nakamura S. Management of Adult Atlantoaxial Rotatory Fixation: Case Series with Literature Review. THE IOWA ORTHOPAEDIC JOURNAL 2023; 43:96-105. [PMID: 38213850 PMCID: PMC10777696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Background Atlantoaxial rotatory fixation (AARF) is extremely rare in adults, and there is no consensus on the ideal treatment of adult AARF because of its rarity. We presented a case series of three adult AARFs and reviewed the literature on adult AARFs. We suggest treatment guidelines for the injury based on the literature review. Methods We compiled a series of three adult AARFs seen in our hospital. We also utilized the NCBI library to retrieve literature on adult AARF from 2000 to 2021. We included articles on adult AARF, which described the number of days from injury to diagnosis, Fielding classification, occurrence of associated cervical injuries, and details of treatment and the results. Results Thirty adult AARFs reports fulfilled the criteria and 32 patients were analyzed. Eighteen patients had Fielding Type 1 AARF and were diagnosed within 1 month of injury. Among them, 13 cases healed with conservative treatment. Patients with acute AARF of Fielding Type 1 who underwent manual reduction healed successfully. All patients that required more than 1 month from injury to diagnosis underwent surgery. All cases with AARF Fielding Types 2, 3, and 4 failed conservative treatment. Conclusion The case series and literature review suggest that early diagnosis of adult AARF is essential for successful closed reduction, and the Fielding classification may help determine treatment strategy. Furthermore, this study showed that not only traction but also manual reduction may be a useful treatment for early diagnosed AARF Fielding Type 1 without complications. Level of Evidence: III.
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Affiliation(s)
- Yusei Katsuyama
- Department of Orthopaedics, Fukuchiyama City Hospital, 231 Atsunaka-cho, Fukuchiyama, Kyoto 620-8505, Japan
| | - Yoshiki Okuda
- Department of Orthopaedics, Fukuchiyama City Hospital, 231 Atsunaka-cho, Fukuchiyama, Kyoto 620-8505, Japan
| | - Hitoshi Kanamura
- Department of Orthopaedics, Fukuchiyama City Hospital, 231 Atsunaka-cho, Fukuchiyama, Kyoto 620-8505, Japan
| | - Kentaro Sasaki
- Department of Orthopaedics, Fukuchiyama City Hospital, 231 Atsunaka-cho, Fukuchiyama, Kyoto 620-8505, Japan
| | - Tomoki Saito
- Department of Orthopaedics, Fukuchiyama City Hospital, 231 Atsunaka-cho, Fukuchiyama, Kyoto 620-8505, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedics, Fukuchiyama City Hospital, 231 Atsunaka-cho, Fukuchiyama, Kyoto 620-8505, Japan
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Muacevic A, Adler JR, ALMohammed AA, Alotaibi AM, Surur S. Surgical Treatment of Irreducible AcuteTraumatic Atlantoaxial Rotatory Subluxation in an Adult. Cureus 2022; 14:e31678. [PMID: 36545162 PMCID: PMC9762917 DOI: 10.7759/cureus.31678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2022] [Indexed: 11/20/2022] Open
Abstract
Traumatic atlantoaxial rotatory subluxation (AARS) is a condition that is extremely rare in adults when compared to the pediatric population. The most common symptoms of this condition are torticollis and post-traumatic neck pain. Our patient is a 41-year-old male who presented to the emergency room within hours of the injury. He came by himself with his relative as a case of road traffic accident. He was the first passenger and had been restrained during the car accident, with no ejection or rollover. He presented with stiffness/pain and reduced range of motion in the neck. Computed tomography (CT) of the cervical spine showed rotatory subluxation of C1 over the C2 with a locked facet. Within 24 hours of the RTA and patient admission, we attempted cervical traction. The reduction was not successful. So, we decided to reduce AARS through a surgical approach. The patient was taken to the operating room for open reduction and fixation using the Harms technique for C1-C2 fusion. The patient recovered from the surgery uneventfully, without any complications, recovered cervical mobility, and improved torticollis. Surgical management through open reduction and internal fixation is recommended for AARD cases in which close reduction fails due to a locked facet.
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Does alar ligament injury predict conservative treatment failure of atlantoaxial rotatory subluxation in adults: Case report and review of the literature. Spinal Cord Ser Cases 2021; 7:103. [PMID: 34862363 DOI: 10.1038/s41394-021-00464-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The alar ligament is an important structure in restraining the rotational movement at the atlantoaxial joint. While bony fractures generally heal, rupture of ligaments may heal poorly in adults and often requires surgical stabilization. Atlantoaxial rotatory subluxation (AARS) is a rare injury in adults, and the prognostic importance of the presence of alar ligament injury with regard to the success of nonoperative management is unknown. CASE PRESENTATION A 28-year-old woman presented after a traumatic Type I AARS without evidence of osseous injury, but MRI demonstrated evidence of unilateral alar ligament disruption. Initial conservative management with closed reduction and maintenance in a rigid cervical collar proved unsuccessful, with worsening pain and failure to maintain reduction. She subsequently underwent open reduction and surgical fixation of C1-C2, resulting in resolution of her pain and maintenance of alignment. DISCUSSION Alar ligament rupture may be a negative prognostic indicator in the success of nonoperative management of type I atlantoaxial rotatory subluxation. Additional study is warranted to better assess whether the status of the alar ligament should be considered an important factor in the management algorithm of type I AARS.
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Singla R, Manjunath N, Sharma R, Mishra S. Neglected Traumatic Atlantoaxial Rotatory Dislocation in Adult: A Case Report. Int J Spine Surg 2020; 14:46-52. [PMID: 32128302 DOI: 10.14444/7006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Atlantoaxial rotatory dislocations (AARDs) are common in the pediatric population and rarely seen in adults. We describe a case of neglected AARD and subsequent management. A 25-year-old man developed a Fielding type 1 AARD following a road traffic accident. He was managed conservatively for 1.5 months before being referred to us. The patient underwent surgery 1.5 months after the accident. Closed reduction failed and C1-2 fixation with the Harms technique was performed after intraoperative reduction resulting in correction of deformity. Delay of treatment makes intraoperative reduction more difficult and increases the possibility of the chronic permanent change of neck muscles and ligaments. Hence, a high index of suspicion with a thorough clinical examination and judicious use of radiological investigations is paramount to the appropriate management of such cases.
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Affiliation(s)
- Raghav Singla
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Niveditha Manjunath
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
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Raghav S, Niveditha M, Ravi S, Shashwat M. Neglected Traumatic Atlantoaxial Rotatory Dislocation in Adult. Int J Spine Surg 2020; 13:531-535. [PMID: 31970048 DOI: 10.14444/6071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Atlantoaxial rotatory dislocations (AARD) are common in the pediatric population and rarely seen in adults. We describe a case of neglected AARD and subsequent management. A 25-year-old man developed a Fielding type 1 AARD following a road traffic accident. He was managed conservatively for 1.5 months before being referred to us. The patient underwent surgery 1.5 months after the accident. Closed reduction failed, and C1-2 fixation with the Harms technique was performed after intraoperative reduction, resulting in correction of deformity. Delay of treatment makes intraoperative reduction more difficult and increases the possibility of the chronic permanent change of neck muscles and ligaments. Hence, a high index of suspicion with a thorough clinical examination and judicious use of radiological investigations is paramount to the appropriate management of such cases.
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Affiliation(s)
- Singla Raghav
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manjunath Niveditha
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sharma Ravi
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mishra Shashwat
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Rahimizadeh A, Williamson W, Rahimizadeh S. Traumatic Chronic Irreducible Atlantoaxial Rotatory Fixation in Adults: Review of the Literature, With Two New Examples. Int J Spine Surg 2019; 13:350-360. [PMID: 31531285 DOI: 10.14444/6048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Atlantoaxial rotatory fixation (AARF) is a rare condition in adults and is almost always due to an accompanying trauma. The first example of traumatic AARF in adults was reported by Corner in 1907 and since then only 55 adult cases with this rare traumatic scenario have been published so far. Approximately 80% of adults with traumatic AARF are diagnosed soon after the traumatic events. However, in the remaining casualties, the condition might be missed with some delay from the diagnosis to treatment. If this pathology is diagnosed early enough, the conservative attempts for a closed reduction are usually effective. After closed reduction, external immobilization is required to prevent recurrence of the dislocation. However, with delayed diagnosis, the condition may remain refractory to traction on manipulation and require an open reduction instead. In the literature, such irreducible chronic AARFs are rarely reported, being confined to only 14 adult examples, in whom surgical intervention for correction of the deformity will be required. In such cases, release of the atlantoaxial facet joints is the first surgical step. In the subsequent step, reduction of the dislocated facet joints can be done via one of the already described maneuvers. As the final step, C1-C2 fixation will be necessary for prevention of re-dislocation. Herein, 2 adult patients with chronic rotatory atlantoaxial dislocation of traumatic origin are presented. In both cases, cranial traction and manipulations were ineffective and therefore an open reduction procedure was proposed and accomplished via the posterior midline corridor. The transverse rod technique was implemented subsequent to the atlantoaxial facet release. After correction of the deformity, a C1-C2 fixation was accomplished followed by arthrodesis. In addition to the outlined procedure, an historical review of the literature on this subject from the beginning of 20th century is demonstrated.
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Affiliation(s)
- Abolfazl Rahimizadeh
- Pars Advanced and Minimally Invasive Manners Medical Research Center, Pars Hospital Affiliated to Iran University of Medical Sciences, Tehran, Iran
| | - Walter Williamson
- Pars Advanced and Minimally Invasive Manners Medical Research Center, Pars Hospital Affiliated to Iran University of Medical Sciences, Tehran, Iran
| | - Shahayegh Rahimizadeh
- Pars Advanced and Minimally Invasive Manners Medical Research Center, Pars Hospital Affiliated to Iran University of Medical Sciences, Tehran, Iran
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Eghbal K, Rakhsha A, Saffarrian A, Rahmanian A, Abdollahpour HR, Ghaffarpasand F. Surgical Management of Adult Traumatic Atlantoaxial Rotatory Subluxation with Unilateral Locked Facet; Case Report and Literature Review. Bull Emerg Trauma 2018; 6:367-371. [PMID: 30402528 PMCID: PMC6215068 DOI: 10.29252/beat-060416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Atlantoaxial rotatory subluxation (AARS) is rarely occurred in adults with trauma as the most common cause. In type A and B it is usually managed with close reduction and external brace; however, in nonresponsive cases, surgical interventions might be needed. Our patient is a 21-year-old man with neck pain and torticollis after a car turn- over. There was C1-C2 rotatory subluxation with left side locked facet and C1 rotation about 40 degrees relative to C2 on computed tomography without evident of ligamentous injury in magnetic resonance imaging (MRI). However, during the first 48 hours, two tries of close reduction using Gardner cervical traction under fluoroscopy were failed. Thus, the patient underwent open reduction of the subluxation and atlantoaxial fixation (Harm’s technique) with subsequent relief of pain and torticollis. This a rare case of traumatic AARS type A with unilateral locked facet joint in an adult patient which needed surgical manipulation for reduction. The management of the AARS in adults should be individualized in each patient.
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Affiliation(s)
- Keyvan Eghbal
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rakhsha
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Orthopedics, Shiraz University of Medical Sciences, Shiraz, Iran.,Resident of Neurosurgery, Student Research Committee, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Saffarrian
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Fariborz Ghaffarpasand
- Resident of Neurosurgery, Student Research Committee, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Traumatic atlantoaxial rotatory fixation in an adult patient. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 28:284-289. [PMID: 28078473 DOI: 10.1007/s00586-016-4916-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/24/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Atlantoaxial rotational fixation (AARF) is a rare entity in adults, with only a few cases reported in the English literature and often associated with a traumatic mechanism. It is an underdiagnosed condition that must be taken into account in the initial assessment of all craniocervical trauma. Both diagnostic and therapeutic delay may be a potential cause of severe neurological damage or even death of the patient. The therapeutic management is controversial given the difficulty of achieving optimum stability and permanent reduction. METHODS AND RESULTS A 28-year-old woman was involved in a traffic accident a week before coming to the emergency with rotation and irreducible cervical flexion from trauma and severe neck pain. CT and MRI column were performed and showed a cervical spinal AARF with transverse and alar ligaments intact and preserved atlantoaxial distance (Fielding I). The patient was treated by progressive cervical traction with 5 kg and manual reduction was completed in 24 h. Subsequently, an external immobilization was performed by cervical rigid collar for 16 weeks. The clinical course was good, with the patient regaining full mobility with cervical neck pain improvement. CONCLUSIONS The purpose of this paper is to show a case of a young woman with a posttraumatic AARF successfully treated conservatively. This case delineates the difficulties in diagnosing this pathology, as well as the challenges encountered in its management.
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Peyneau PD, Roque-Torres GD, Godolfim LR, Costa EDD, Almeida SMD, Ambrosano GMB. Rotation of the second cervical vertebra in pediatric patient. EINSTEIN-SAO PAULO 2016; 14:575-576. [PMID: 28076609 PMCID: PMC5221388 DOI: 10.1590/s1679-45082016ai3631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/12/2016] [Indexed: 11/22/2022] Open
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