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Spontaneous Ankylosis of Occiput to C2 following Closed Traction and Halo Treatment of Atlantoaxial Rotary Fixation.

Krengel WF, Kim PH, Wiater B - Global Spine J (2015)

Bottom Line: Imaging demonstrated dislocation of the left C1-C2 facet joint and remodeling changes of the C2 superior facet prior to reduction, followed by near complete reduction of the dislocation after manipulation and halo placement.The patient was found to be HLA B27-positive, but he had no family history of ankylosing spondyloarthropathy or other joint symptoms.The underlying reasons for spontaneous fusion of the occiput to C2 could include the traction, HLA-B27-related spondyloarthropathy, or arthropathic changes caused by traction, reduction, the inciting insult, or immobilization.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Seattle Children's Hospital and University of Washington, Seattle, Washington, United States.

ABSTRACT
Study Design Case report. Objective We report a case of spontaneous atlantoaxial rotatory fixation (AARF) presenting 9 months after onset in an 11-year-old boy. Methods This is a retrospective case report of spontaneous ankylosis of occiput to C2 following traction, manipulative reduction, and halo immobilization for refractory atlantoaxial rotatory fixation. Results The patient underwent traction followed by close manual reduction and placement of halo immobilization after 6 months of severe spontaneous-onset AARF that had been refractory to chiropractic manipulation and physical therapy. Imaging demonstrated dislocation of the left C1-C2 facet joint and remodeling changes of the C2 superior facet prior to reduction, followed by near complete reduction of the dislocation after manipulation and halo placement. Symptoms and clinical appearance were satisfactorily improved and the halo vest was removed after 3 months. At late follow-up, computed tomography demonstrated complete bony ankylosis of the occiput to C2. The patient was found to be HLA B27-positive, but he had no family history of ankylosing spondyloarthropathy or other joint symptoms. The underlying reasons for spontaneous fusion of the occiput to C2 could include the traction, HLA-B27-related spondyloarthropathy, or arthropathic changes caused by traction, reduction, the inciting insult, or immobilization. Conclusion When discussing treatment of childhood refractory AARF by traction, closed manipulation, and halo immobilization, the possibility of developing "spontaneous" ankylosis needs to be considered.

No MeSH data available.


Related in: MedlinePlus

Six months' follow-up postreduction sagittal reconstruction computed tomography through right C1–C2 facet. Note solid bony ankylosis of occiput to C2. Lower cervical facets appear normal.
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FI1400022cr-7: Six months' follow-up postreduction sagittal reconstruction computed tomography through right C1–C2 facet. Note solid bony ankylosis of occiput to C2. Lower cervical facets appear normal.

Mentions: Three months following reduction, his halo vest was removed. His neurologic exam at that time showed that his deltoid weakness had improved to functional insignificance but had not completely resolved. Some rotational malalignment was still present, but the left C1–C2 facet was not dislocated. Increasing signs of spontaneous ankylosis of the left C1–C2 facet were present. The family declined surgical treatment as they felt his clinical improvement was acceptable. Mild residual torticollis was present. Six months after reduction, a CT scan was obtained and can be seen in Figs. 7, 8, and 9. The patient's final picture is depicted in Fig. 10.


Spontaneous Ankylosis of Occiput to C2 following Closed Traction and Halo Treatment of Atlantoaxial Rotary Fixation.

Krengel WF, Kim PH, Wiater B - Global Spine J (2015)

Six months' follow-up postreduction sagittal reconstruction computed tomography through right C1–C2 facet. Note solid bony ankylosis of occiput to C2. Lower cervical facets appear normal.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4472283&req=5

FI1400022cr-7: Six months' follow-up postreduction sagittal reconstruction computed tomography through right C1–C2 facet. Note solid bony ankylosis of occiput to C2. Lower cervical facets appear normal.
Mentions: Three months following reduction, his halo vest was removed. His neurologic exam at that time showed that his deltoid weakness had improved to functional insignificance but had not completely resolved. Some rotational malalignment was still present, but the left C1–C2 facet was not dislocated. Increasing signs of spontaneous ankylosis of the left C1–C2 facet were present. The family declined surgical treatment as they felt his clinical improvement was acceptable. Mild residual torticollis was present. Six months after reduction, a CT scan was obtained and can be seen in Figs. 7, 8, and 9. The patient's final picture is depicted in Fig. 10.

Bottom Line: Imaging demonstrated dislocation of the left C1-C2 facet joint and remodeling changes of the C2 superior facet prior to reduction, followed by near complete reduction of the dislocation after manipulation and halo placement.The patient was found to be HLA B27-positive, but he had no family history of ankylosing spondyloarthropathy or other joint symptoms.The underlying reasons for spontaneous fusion of the occiput to C2 could include the traction, HLA-B27-related spondyloarthropathy, or arthropathic changes caused by traction, reduction, the inciting insult, or immobilization.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Seattle Children's Hospital and University of Washington, Seattle, Washington, United States.

ABSTRACT
Study Design Case report. Objective We report a case of spontaneous atlantoaxial rotatory fixation (AARF) presenting 9 months after onset in an 11-year-old boy. Methods This is a retrospective case report of spontaneous ankylosis of occiput to C2 following traction, manipulative reduction, and halo immobilization for refractory atlantoaxial rotatory fixation. Results The patient underwent traction followed by close manual reduction and placement of halo immobilization after 6 months of severe spontaneous-onset AARF that had been refractory to chiropractic manipulation and physical therapy. Imaging demonstrated dislocation of the left C1-C2 facet joint and remodeling changes of the C2 superior facet prior to reduction, followed by near complete reduction of the dislocation after manipulation and halo placement. Symptoms and clinical appearance were satisfactorily improved and the halo vest was removed after 3 months. At late follow-up, computed tomography demonstrated complete bony ankylosis of the occiput to C2. The patient was found to be HLA B27-positive, but he had no family history of ankylosing spondyloarthropathy or other joint symptoms. The underlying reasons for spontaneous fusion of the occiput to C2 could include the traction, HLA-B27-related spondyloarthropathy, or arthropathic changes caused by traction, reduction, the inciting insult, or immobilization. Conclusion When discussing treatment of childhood refractory AARF by traction, closed manipulation, and halo immobilization, the possibility of developing "spontaneous" ankylosis needs to be considered.

No MeSH data available.


Related in: MedlinePlus