Delayed diagnosis of a spontaneous atlanto-axial rotatory dislocation

Abstract

Without any known specific cause a 3-year-old boy developed a torticollis. Although the symptoms were treated immediately there was no improvement. Four months later X-rays showed that the dens-atlas distance was enlarged. In spite of this, he was treated by tenotomy and intensive physiotherapy, but the torticollis remained. Two years later a tomogram and a CT showed a complete rotatory dislocation between atlas and axis. At this stage it was impossible to treat the original cause. Physiotherapy was continued to improve the position of the head.

Therapeutic options and results following fixed atlantoaxial rotatory dislocations

“…Fixed AARD has to be discerned from acute torticollis, in which motion can be demonstrated between C1 and C2 [12]. Because of the rare incidence and the discrete pathological changes on conventional X-rays, the final diagnosis of AARD is frequently delayed [7,8,19,22,23]. The exact anterior-posterior view on plain radiographs will always illustrate an eccentric position of the odontoid process.…”

“…Frequently, there is a considerable delay in establishing the proper diagnosis (weeks or months after the initial dislocation), since the pathological changes depicted on the conventional radiographs are only discrete. Additionally, this entity is rarely considered in the routine diagnostic work-up of torticollis [1,7,8,22,23,31].…”

Delayed closed reduction of rotatory atlantoaxial dislocation in an adult

“…It is rare in adults. Torticollis is the presenting syndrome, and the dislocation can be missed [2,15,25]. CT increases the likelihood of making the diagnosis [2,19,30] and, when images in rotation are obtained, is useful for evaluating reducibility of the lesion [2,14,26].…”