• Journal of Korean Neurosurgical Society
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• 제55권5호
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• pp.284-288
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• 2014

A rare case of atlantoaxial rotatory subluxation occurred after pediatric cervical spine surgery performed to remove a dumbbell-shaped meningioma at the level of the C1/C2 vertebrae. This case is classified as a post-surgical atlantoaxial rotatory subluxation, but has a very rare morphology that has not previously been reported. Although there are several reports about post-surgical atlantoaxial rotatory subluxation, an important point of this case is that it might be directly related to the spinal cord surgery in C1/C2 level. On day 6 after surgery, the patient presented with the Cock Robin position, and a computed tomography scan revealed a normal type of atlantoaxial rotatory subluxation. Manual reduction was performed followed by external fixation with a neck collar. About 7 months after the first surgery, the subluxation became severe, irreducible, and assumed an atypical form where the anterior tubercle of C1 migrated to a cranial position, and the posterior tubercle of C1 and the occipital bone leaned in a caudal direction. The pathogenic process suggested deformity of the occipital condyle and bilateral C2 superior facets with atlantooccipital subluxation. A second operation for reduction and fixation was performed, and the subluxation was stabilized by posterior fixation. We encountered an unusual case of a refractory subluxation that was associated with an atypical deformity of the upper spine. The case was successfully managed by posterior fixation.

• Clinical Pain
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• 제18권2호
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• pp.92-96
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• 2019

Torticollis is an abnormal, asymmetric head or neck position which usually caused by imbalance of paracervical muscles. The traumatic torticollis can be caused by following events; atlantoaxial rotatory subluxation, atlantoaxial dislocation, cervical vertebral fractures, and injury to the cervical musculature. Especially, acute traumatic atlantoaxial rotatory subluxation usually presents limitation of cervical range of motion without pain or neurologic deficit. We report a case of a 58 year-old man who developed the acute atlantoaxial rotatory subluxation right after the chiropractic therapy, which induced the limitation of cervical range of motion to 52.5% of normal range. The magnetic resonance image revealed the facture of the odontoid process and the partial injury in transverse ligaments of the atlas. He underwent intramuscular botulinum toxin injection and 10 days of continuous cervical traction 15 hours a day using a 5 kg weight. The range of the cervical motion restored up to 90.2% of normal range.

• 대한정형도수물리치료학회지
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• 제25권1호
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• pp.71-76
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• 2019

Background: An 8-year-old girl had severe neck pain and stiffness after trauma. CT scan showed atlantoaxial rotatory subluxation (AARS). She had conservative treatment because she did not have neurological symptoms and spinal basilar artery dysfunction. Conservative therapy was halter traction twice for 4 weeks. However, pain and stiffness persisted. She had been recommended to have surgery from her physician, but she received manual therapy for non-surgical procedures. Methods: The joint mobilization, muscle energy technique, motor control exercise, and deep neck flexor (DNF) endurance exercise were applied as manual therapy and 10 session for 2weeks. Results: Clinical outcomes were measured at initial baseline, after 2 weeks, and after 6weeks. Active range of motion was completely restored after 6weeks and numeric pain rating scale was completely reduced after 2 weeks. The strength of neck flexor muscle recovered to normal after 2 weeks, and the DNF endurance was improved to 25 seconds after 2 weeks and to 42 seconds after 6weeks. Motor control capacity recovered to 30 ㎜Hg after 2 weeks. Conclusions: This case report describes the immediate and short-term clinical outcomes for a patient presenting with symptoms of neck pain following AARS. Clinical rationale and patient preference aided the decision to incorporate manual therapy as a treatment for this patient. Manual therapy has shown a successful recovery in AARS patients, more research is needed to validate the inference of this case report.

• 대한두개안면성형외과학회지
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• 제25권2호
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• pp.85-89
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• 2024

Postoperative atlantoaxial rotatory subluxation (AARS) is a rare complication that develops almost exclusively in children following oropharyngeal and otologic surgeries, proposing that oropharyngeal inflammatory responses and excessive head rotation are responsible factors. However, there have been no reports of AARS after excision of a nevus on the head and neck. Here, we present two cases of AARS following limited head rotation during simple nevus excision. Patient 1, a 9-year-old girl, complained of neck pain and limited range of motion after excision of the nevus on the neck. After 2 months, computed tomography and magnetic resonance imaging finally revealed AARS with a ruptured transverse atlantal ligament. A month of halo traction was required for the treatment. Patient 2, an 11-year-old girl, presented with immediate pain and limited neck extension after tissue expander insertion under the upper chest and excision of the nevus on her left cheek. The diagnosis was promptly made using cervical spine radiography. A cervical collar was applied for 1 month. Both patients recovered without any complications after treatment. This report highlights the importance of suspicion for AARS after surgery regardless of surgical duration or amount of head rotation.

• Journal of Korean Neurosurgical Society
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• 제45권4호
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• pp.246-248
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• 2009

Atlantoaxial rotatory fixation (AARF) in adult is a rare disorder that occurs followed by a trauma. The patients were presented with painful torticollis and a typical 'cock robin' position of the head. The clinical diagnosis is generally difficult and often made in the late stage. In some cases, an irreducible or chronic fixation develops. We reported a case of AARF in adult patient which was treated by immobilization with conservative treatment. A 25-year-old female was presented with a posterior neck pain and limitation of motion of cervical spine after a traffic accident. She had no neurological deficit but suffered from severe defect on the scalp and multiple thoracic compression fractures. Plain radiographs demonstrated torticollis, lateral shift of odontoid process to one side and widening of one side of C1-C2 joint space. Immobilization with a Holter traction were performed and analgesics and muscle relaxants were given. Posterior neck pain and limitation of the cervical spine' motion were resolved. Plain cervical radiographs taken at one month after the injury showed that torticollis disappeared and the dens were in the midline position. The authors reported a case of type I post-traumatic AARF that was successfully treated by immobilization alone.