A missed traumatic atlanto-axial rotatory subluxation in an adult patient: case report

Abstract

BackgroundTraumatic atlanto-axial rotatory subluxation (AARS) in an adult is a rare condition, which if left untreated can be fatal. In addition to this, many symptoms experienced such as neck pain and stiffness are non-specific which often leads to misdiagnosis, thus delaying definitive treatment. AARS can be divided into traumatic and non-traumatic causes with the latter generally encompassing congenital cervical spine abnormalities.Case presentationWe present a case of a 66-year-old female with traumatic rotatory AARS, which was initially misdiagnosed in the emergency department. This patient was subsequently recalled to the hospital when the misdiagnosis was spotted the following day from imaging results. The patient was initially managed conservatively as an inpatient using head halter cervical traction which proved to give good clinical reduction allowing discharge with Miami J upon ambulation. Upon follow up the patient was experiencing continuous pain but remained neurovascularly intact. She thus opted for definitive management with C1–C2 stabilization with an open reduction and internal fixation.ConclusionThis case demonstrates the importance of having a high index of suspicion to diagnose AARS in cervical spine trauma presenting to the emergency department, until exclusion can be made using imaging and clinical examination.

Successful Cases of Closed Reduction of Chronic Traumatic Atlantoaxial Rotatory Dislocation: A Report of Two Cases

“…About 90% of cases involve those aged less than 21 years old. The factors that predispose it to happen in children are a giant head, underdeveloped neck musculature, a more lax joint capsule, the horizontal configuration of the atlantoaxial articular facets, and the interspinous ligaments that are elastic and flexible [ 1 ].…”

“…The causes of atlantoaxial rotatory dislocation (AARD) can be either traumatic or nontraumatic [ 1 ]. This condition can lead to complete paralysis due to proximal spinal cord compression if neglected and left untreated.…”

Atlantoaxial rotatory subluxation presenting as acute torticollis after mild trauma

“…Recognition of AARS after trauma requires a high index of suspicion, in adults neurologic complications are more common than in children [4] . Prompt diagnosis significantly increases chances for closed reduction to be successful as well as decreases the rate of recurrence [6 , 7] . CT is the imaging modality of choice to make the diagnosis since radiographs are difficult to interpret due to positioning issues and the complicated anatomy of the atlanto-axial region [8] .…”

“…The most common presentation of AARS is a “cock-robin” position of the neck followed by a suboccipital headache [5] . This looks like torticollis, with the head tilted to 1 side, rotation to the contralateral side, and decreased range of neck motion [6] . We describe a case of AARS presenting as acute torticollis after mild trauma in a middle-aged female.…”

Traumatic Atlantoaxial Rotatory Subluxation in Adult: Case Report

“…These injuries vary regarding their gravity and affected structures as they can present themselves exclusively with muscle pain, or even subluxation, luxation and serious fractures. 3 In this context, traumatic AARS is hardly documented in adults and, for that reason, not many cases could be found in the current literature. 4 It possibly presents itself through cervicalgia (neck pain), headache and neck stiffness, usually with no neurologic deficit.…”