Traumatic atlantoaxial rotatory subluxation in adults – A case report and literature review

Horsfall, Hugo Layard; Gharooni, Aref-Ali; Al-Mousa, Alaa; Shtaya, Anan; Pereira, Erlick

doi:10.25259/sni_671_2020

Cited by 8 publications

(3 citation statements)

References 6 publications

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“…The most commonly used classification is Fielding and Hawkins [ 20 , 21 ] ( Figure 2 ). Type I consists of a unilateral anterior rotation of an atlas mass that pivots around the odontoid while maintaining the integrity of the transverse ligament of the atlas [ 20 , 21 , 22 ]. As indicated by Ng et al [ 23 ], rupture of the alar ligament may be a negative prognostic indicator for the success of non-surgical treatment of type I atlantoaxial rotator subluxation.…”

Section: Etiologymentioning

confidence: 99%

C1-C2 Rotatory Subluxation in Adults “A Narrative Review”

González

Aragón

Sanjuan³

et al. 2022

Diagnostics

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The atlantoaxial joint C2 (axis) with the anterior arch of C1 (atlas) allows 50% of cervical lateral rotation. It is responsible for precise and important movements that allow us to perform precise actions, both in normal and working life. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed and the outcome is worse. An early diagnosis and treatment are essential to ensure satisfactory neurological and functional outcomes. The aim of this review is to analyze C1-C2 rotatory subluxation in adults, given its rarity. The time between injury and reduction is key, as it is directly related to prognosis and the severity of the treatment options. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed as a lot of cases are not related to a clear trauma, with a poor prognosis just because of the late diagnosis and the outcome is worse. The correct approach and treatment of atlantoaxial dislocation requires a careful study of the radiological findings to decide the direction and plane of the dislocation, and the search for associated skeletal anomalies.

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Section: Etiologymentioning

confidence: 99%

C1-C2 Rotatory Subluxation in Adults “A Narrative Review”

González

Aragón

Sanjuan³

et al. 2022

Diagnostics

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“…Actualmente es difícil tener una cifra exacta de incidencia de esta entidad, existen reportes en los que se encuentran presentes en 6-20% de los accidentes mortales. 15,16 Siendo este tipo de lesiones conocidas como una de las causas principales de mortalidad; se estima que represente de 8-15% de las muertes inmediatas por traumatismos cerrados de alta velocidad. Las causas del error diagnóstico son multifactoriales e incluyen: baja sospecha clínica, inexperiencia en la evaluación radiográfica, además de politraumatismos graves.…”

Section: Introductionunclassified

Inestabilidad occipitoatloidea y atlantoaxial traumática combinada. Reporte de un caso

Trujillo-Franco,

Gutiérrez-Herrera,

Bautista-Sandoval

2024

Ortho-Tips

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Introducción: las lesiones de la unión cráneo-cervical con inestabilidad secundaria a traumatismos son poco frecuentes; con complicaciones con un alto índice de mortalidad. Cuando ambas lesiones están presentes, el pronóstico de supervivencia y recuperación del paciente suele ser muy pobre. El tratamiento quirúrgico de reconstrucción de la unión occipitocervical es un procedimiento complejo y poco común; en la mayoría de las ocasiones se ha estudiado en tratamiento de patologías degenerativas y reumáticas. Caso clínico: paciente femenino de 27 años, con inestabilidad occipitoatloidea-atlantoaxoidea combinada, secundaria a accidente en vehículo tipo motocicleta; la cual presenta múltiples lesiones. Diagnóstico: clínica con déficit neurológico; estudios radiológicos de trauma, y tomografía axial de cráneo y columna vertebral evidencian datos de inestabilidad a nivel de C0-C1 y C1-C2. Intervenciones: manejo multidisciplinario y posteriormente reducción y fijación occipitocervical con técnica Harms de las lesiones por inestabilidad vertebral traumática, C0-C1, C1-C2 y C2-C3. Seguimiento: a nueve meses de la intervención, con adecuada evolución clínica. Conclusiones: aunque existen pocas publicaciones y guías sobre el diagnóstico, momento ideal de intervención y método de estabilización óptimo en casos de inestabilidad por trauma, recomendamos un abordaje multidisciplinario. El diagnóstico y tratamiento precoz influye directamente en el pronóstico final y calidad de vida de estos pacientes.

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“…Atlantoaxial subluxation is uncommon, and early detection and treatment are critical to achieving positive neurological results. Because of the specific biomechanics of these injuries, care for such traumatic unilateral atlantoaxial rotatory subluxation (AARS) differs; they frequently necessitate a personalised approach [ 1 ]. The currently accepted method for posterior cervical fusion uses lateral mass screw (LMS) fixation with plates or rods.…”

Section: Introductionmentioning

confidence: 99%

Physiotherapeutic Approach Towards Sensory and Motor Recovery in a Patient With Lateral Mass Fixation: A Report of a Rare Case

Kapre,

Harjpal,

Mandhane

et al. 2024

Cureus

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Atlantoaxial dislocations (AAD) are a diverse set of C1-C2 rotatory subluxations that include the inferior and superior axial facet articulations. C1-C2 segments are both covered by cranial-cervical ligaments, indicating that AAD would damage both joints. Whenever the posterior elements are missing or impaired, lateral mass screw fixation has replaced alternative posterior cervical fixation procedures as the preferred treatment for securing the sub-axial cervical spine. An increase in muscle tone, hyperreflexia, pathological reflexes, digit/hand clumsiness, and gait deviations caused by spinal cord compression at the cervical level are the most common clinical features. A 23-year-old female patient came with the chief complaint of weakness, tingling sensation, and numbness in both upper and lower limbs along with imbalance while walking. She had a history of falls which was managed conservatively. As the symptoms progressed, an MRI, a CT scan, and an X-ray of the neck were done to rule out the level of injury which revealed AAD, and the patient was operated on for C1-C2 lateral mass fixation. Post-operatively, the patient was referred to the physiotherapy department for further management. The patient's quality of life and daily functioning were positively affected after undergoing early intervention as measured by the

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Traumatic atlantoaxial rotatory subluxation in adults – A case report and literature review

Cited by 8 publications

References 6 publications

C1-C2 Rotatory Subluxation in Adults “A Narrative Review”

C1-C2 Rotatory Subluxation in Adults “A Narrative Review”

Inestabilidad occipitoatloidea y atlantoaxial traumática combinada. Reporte de un caso

Physiotherapeutic Approach Towards Sensory and Motor Recovery in a Patient With Lateral Mass Fixation: A Report of a Rare Case

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