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Traumatic atlantoaxial rotatory subluxation in an adolescent: a case report.

Meza Escobar LE, Osterhoff G, Ossendorf C, Wanner GA, Simmen HP, Werner CM - J Med Case Rep (2012)

Bottom Line: Early reduction three hours after trauma and immobilization using only a soft collar were performed and yielded very good clinical results.Early treatment implies a non-surgical approach and a good outcome.Conservative treatment is the recommended first step for this condition.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Division of Trauma Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. georg.osterhoff@usz.ch.

ABSTRACT

Introduction: Atlantoaxial rotatory subluxation is rarely caused by trauma in adults. Usually, the treatment of choice is traction using Halo/Gardner-Wells fixation devices for up to six weeks.

Case presentation: We present the case of a 19-year-old Caucasian woman with traumatic atlantoaxial subluxation. Early reduction three hours after trauma and immobilization using only a soft collar were performed and yielded very good clinical results.

Conclusion: In the adult population, atlantoaxial subluxation is a rare condition but is severe if untreated. Early treatment implies a non-surgical approach and a good outcome. Conservative treatment is the recommended first step for this condition.

No MeSH data available.


Related in: MedlinePlus

Atlantoaxial computed tomography scan. Atlantoaxial rotation of 46° to the left.
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Figure 1: Atlantoaxial computed tomography scan. Atlantoaxial rotation of 46° to the left.

Mentions: While driving a van and wearing a seatbelt, a 19-year-old Caucasian woman, was involved in a head-on vehicle collision (speed about 40 km/hour), followed by a rear-end hit from another vehicle. When rescue services arrived at the scene, the patient was found sitting in her car with her head immobilized in a left rotation. She was transferred onto a spinal board. The application of a stiff neck collar was not possible as her head was fixed in the rotated position. After admittance to a regional hospital, the physician in charge tried to reposition her head but she reported painful paresthesia in the left arm. She was transferred to our spine and trauma center. Upon admittance, the woman complained about strong, immobilizing pain in the upper cervical spine with torticollis to the left side. A computed tomography (CT) scan revealed an atlantoaxial rotation of 46° to the left without any signs of osseous lesions (Figure 1). The neck was then reduced by cautious rotation under traction with the cervical spine in flexion thus avoiding harm by potential posttraumatic disc lesions. During this process, the patient was awake and did not report any new paresthetic sensations during the procedure. There were no clinical signs of neurological sequelae before or after reduction. However, a fluoroscopic control still showed signs of atlantoaxial pathology (Figure 2) and magnetic resonance imaging (MRI) of the cervical spine was done (Figure 3). It showed the integrity of the transverse and the alar ligaments and a traumatic discus protrusion on level C5/6 (Figure 4). After three days of immobilization and analgesic therapy, a CT (with maximum bilateral head rotation) showed no persisting atlantoaxial fixation (Figure 5). Subsequently, she was discharged three days after admittance and immobilized in a soft collar for six weeks. At a follow-up examination six weeks after the trauma, the pain and paresthesia in the left arm had receded completely and the patient had a full range of motion. A follow-up MRI of the cervical spine showed only slight persistent atlantoaxial rotational displacement of C1/2.


Traumatic atlantoaxial rotatory subluxation in an adolescent: a case report.

Meza Escobar LE, Osterhoff G, Ossendorf C, Wanner GA, Simmen HP, Werner CM - J Med Case Rep (2012)

Atlantoaxial computed tomography scan. Atlantoaxial rotation of 46° to the left.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3275470&req=5

Figure 1: Atlantoaxial computed tomography scan. Atlantoaxial rotation of 46° to the left.
Mentions: While driving a van and wearing a seatbelt, a 19-year-old Caucasian woman, was involved in a head-on vehicle collision (speed about 40 km/hour), followed by a rear-end hit from another vehicle. When rescue services arrived at the scene, the patient was found sitting in her car with her head immobilized in a left rotation. She was transferred onto a spinal board. The application of a stiff neck collar was not possible as her head was fixed in the rotated position. After admittance to a regional hospital, the physician in charge tried to reposition her head but she reported painful paresthesia in the left arm. She was transferred to our spine and trauma center. Upon admittance, the woman complained about strong, immobilizing pain in the upper cervical spine with torticollis to the left side. A computed tomography (CT) scan revealed an atlantoaxial rotation of 46° to the left without any signs of osseous lesions (Figure 1). The neck was then reduced by cautious rotation under traction with the cervical spine in flexion thus avoiding harm by potential posttraumatic disc lesions. During this process, the patient was awake and did not report any new paresthetic sensations during the procedure. There were no clinical signs of neurological sequelae before or after reduction. However, a fluoroscopic control still showed signs of atlantoaxial pathology (Figure 2) and magnetic resonance imaging (MRI) of the cervical spine was done (Figure 3). It showed the integrity of the transverse and the alar ligaments and a traumatic discus protrusion on level C5/6 (Figure 4). After three days of immobilization and analgesic therapy, a CT (with maximum bilateral head rotation) showed no persisting atlantoaxial fixation (Figure 5). Subsequently, she was discharged three days after admittance and immobilized in a soft collar for six weeks. At a follow-up examination six weeks after the trauma, the pain and paresthesia in the left arm had receded completely and the patient had a full range of motion. A follow-up MRI of the cervical spine showed only slight persistent atlantoaxial rotational displacement of C1/2.

Bottom Line: Early reduction three hours after trauma and immobilization using only a soft collar were performed and yielded very good clinical results.Early treatment implies a non-surgical approach and a good outcome.Conservative treatment is the recommended first step for this condition.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Division of Trauma Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. georg.osterhoff@usz.ch.

ABSTRACT

Introduction: Atlantoaxial rotatory subluxation is rarely caused by trauma in adults. Usually, the treatment of choice is traction using Halo/Gardner-Wells fixation devices for up to six weeks.

Case presentation: We present the case of a 19-year-old Caucasian woman with traumatic atlantoaxial subluxation. Early reduction three hours after trauma and immobilization using only a soft collar were performed and yielded very good clinical results.

Conclusion: In the adult population, atlantoaxial subluxation is a rare condition but is severe if untreated. Early treatment implies a non-surgical approach and a good outcome. Conservative treatment is the recommended first step for this condition.

No MeSH data available.


Related in: MedlinePlus