Therapeutic options and results following fixed atlantoaxial rotatory dislocations

Abstract

Atlantoaxial rotatory dislocation (AARD) represents a rare pathological condition of the upper cervical spine that is frequently misdiagnosed, leading to a delay in therapy. In a long-term assessment of clinical and radiological results, three different therapeutic options with regard to the length of the dislocation-therapy interval (DTI) were evaluated. Twenty-six patients were treated for AARD from December 1988 until April 2000. Proper diagnosis was established after an average interval of 15 months. Three different therapeutical protocols were followed in order to reduce the dislocation: (1) closed transoral reposition under general anesthesia; (2) temporary transoral fixation utilizing the Harms T-plate; (3) definitive transoral fusion. The eight patients treated by closed reduction had the best pain relief. The average visual analogue scale (VAS) score was 96.6 points, while the rotatory motion of the upper cervical spine, as assessed by dynamic MRI, was 25.3 degrees to each side. The length of the dislocation-therapy-interval (DTI) averaged 1.4 months. A mean VAS Score of 92.3 points was recorded in the ten patients treated with a temporary fixation of C1/C2. In this subgroup the DTI had an average length of 5.3 months. The mean rotation to each side was 13.9 degrees . In the eight patients who underwent definitive fusion the mean VAS score was 60.6 points, while the average length of the DTI was 40.5 months. In conclusion, the clinical outcome and the subjective well-being following AARD deteriorates with increasing length of the dislocation-therapy interval.

Non-traumatic Atlanto-axial Rotatory Subluxation- Grisel’s Syndrome Case Report and Literature Review

“…Initial treatment in acute cases in the agreement of many authors is usually conservative, including bed rest, a cervical collar, analgesics, anti-inflammatory medications, muscle relaxants and, antibiotic therapy, when appropriate, also abscess drainage [8,19]. Barcelos et al has recommended the use of a soft cervical collar molded to the height of the neck at acute phase due to cervical posture which prevents the use of a rigid cervical collar.…”

“…Definitive treatment should be established after reduction [16,21,22]. Here we would like to emphasize the fact that the most important step is to apply rigid retention and immobilization such as a Halo vest [19].…”

“…Surgical treatment is reserved and indicated in cases of failure of conservative treatment, recurrence of subluxation and irreducible subluxations, although, according to Jeszenszky, rarely needed [19].…”

Traumatic Atlantoaxial Rotatory Fixation with Accompanying Odontoid and C2 Articular Facet Fracture

“…The treatment options include conservative care, immobilization, traction, manual reduction and surgery. Conservative treatment is the first step to treat fixed AARF if the transverse ligament is intact 13) . Surgical reduction and internal fixation are indicated in the following case : when conservative measures fail to reduce fixed AARD, in the case of re-dislocation and for highly unstable injuries 8,12) .…”

“…Although acute AARF is thought to be easily reduced, an AARF associated with a facet fracture is difficult to correct 7) . If closed reduction is unsuccessful, then open reduction must be performed 13) . However, we did not perform manual reduction under general anesthesia as well as open reduction.…”