Abstract
Atlanto-axial rotatory fixation is a rare cause of childhood torticollis. It may occur spontaneously or may be associated with trauma, upper respiratory tract infection or congenital abnormality of the cervical spine. Presentation is usually with persistent torticollis and “cock robin” deformity of the neck. In this paper the radiological experience in three patients is presented. Investigations included plain radiographs, plain anteroposterior tomography, CT and MRI. Displacement of the lateral mass of the atlas and the eccentric position of the odontoid peg can be seen in the plain films. CT scan can exclude fractures and confirm atlanto-axial rotation. The superimposition of CT images is demonstrated as a way of diagnosing subluxation. MRI offers better soft tissue differentiation and allows assessment of the integrity of the transverse ligament. This has an important bearing on the prognosis and may influence surgical treatment. It is important to recognise the plain film features of this uncommon condition and confirm the diagnosis with CT or MRI. The treatment options are discussed with particular reference to long term outcome.
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Altongy JF, Fielding JW (1990) Combined atlanto-axial and occipito-atlantal rotatory subluxation. J Bone Joint Surg Am 72:923–926
Bredenkamp JK, Maceri DR (1990) Inflammatory torticollis in children. Arch Otolaryngol Head Neck Surg 116:310–313
Burkus JK, Deponte RJ (1986) Chronic atlanto-axial rotatory fixation correction by cervical spine traction, manipulation and bracing. J Paediatr Orthop 6:631–635
Cattel HS, Filtzer DL (1965) Pseudosubluxation and other normal variations in the cervical spine in children. A study of one hundred and sixty children. J Bone Joint Surg Am 47:774–777
Corner EM (1907) Rotatory dislocation of the atlas. Ann Surg 45:9–26
Dickman CA, Mamourian A, Sonntag VKH, Drayer BP (1991) Magnetic resonance imaging of the transverse atlantal ligament for the evaluation of the atlantoaxial instability. J Neurosurg 75:221–227
Fielding JW, Hawkins RJ (1977) Atlanto-axial rotatory fixation (fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am 59:37–44
Fielding JW, Hawkins RJ, Hensinger RN, Francis WR (1978) Atlantoaxial rotatory deformities. Orthop Clin North Am 9:955–967
Fielding JW, Stillwell WT, Chynn KY, Spyropoulos EC (1978) Use of computer tomography for the diagnosis of atlanto-axial rotatory fixation: a case report. J bone Joint Surg Am 60:1102–1104
Grøgaard B, Dullerud R, Magnæs B (1993) Acute torticollis in children due to atlanto-axial rotatory fixation. Arch Orthop Trauma Surg 112:185–188
Johnson DP, Ferguson CM (1986) Early diagnosis of atlanto-axial rotatory fixation. J Bone Joint Surg Br 68:698–701
Kawabe N, Hirotani H, Tanaka O (1989) Pathomechanism of atlantoaxial rotatory fixation in children. J Pediatr Orthop 9:569–574
Kowalski HM, Cohen WA, Cooper P, Wisoff JH (1987) Pitfalls in the CT diagnosis of atlanto-axial rotatory subluxation. Am J Neuroradiol 8:697–702
Moss JG, Sellar RJ, Bradnock B (1989) Atlanto-axial rotatory fixation: diagnosis by functional computed tomography. Br J Radiol 62:755–758
Murray JB, Ziervogel M (1990) The value of computed tomography in the diagnosis of atlanto-axial rotatory fixation. Br J Radiol 63:894–897
Richaud J (1990) New technique for posterior intra-articular arthrodesis using a single-block graft in cases of atlanto-axial instability. Child's Nerv Syst 6:412–415
Van Holsbeeck EMA, Mackay NNS (1989) Diagnosis of acute atlanto-axial rotatory fixation. J Bone Joint Surg Br 71:90–91
Wortzman G, Dewar FP (1968) Rotatory fixation of the atlanto axial joint: rotational atlanto axial subluxation. Radiology 90:479–487
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Maheshwaran, S., Sgouros, S., Jeyapalan, K. et al. Imaging of childhood torticollis due to atlanto-axial rotatory fixation. Child's Nerv Syst 11, 667–671 (1995). https://doi.org/10.1007/BF00262228
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DOI: https://doi.org/10.1007/BF00262228