title: Atlantoaxial facet locking: treatment by facet manipulation and fixation. Experience in 14 cases.
abstract: The authors report their experience with 14 children in whom acute torticollis or a fixed flexion neck deformity developed. Other than neck deformity, there was no other significant functional or neurological symptom. Although several possible pathogenetic factors have been speculated, the exact cause remains unknown. Conservative observation and/or attempts at closed reduction failed to effect deformity resolution. Investigations revealed "locking" of facets that resulted in rotatory or translatory atlantoaxial dislocation depending on the nature of facet dislocation. The management issues in such cases are evaluated. The authors discuss the validity of atlantoaxial facet distraction and manipulation/reduction and fixation under direct visualization. In all cases recovery from neck deformity was significant immediately after surgery. The deformity resolution was sustained during a mean follow-up period of 23 months (range 3-52 months), although the range of neck movements remained marginally restricted. The craniovertebral realignment is demonstrated by images and clinical photographs.
authors.affiliation: Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India. atulgoel62@hotmail.com
authors.forename: Atul
authors.initials: A
authors.lastname: Goel
authors.forename: Abhidha
authors.initials: A
authors.lastname: Shah
mesh_terms: D000208:Acute Disease; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008349:Manipulation, Orthopedic; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D013123:Spinal Fusion; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014103:Torticollis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014143:Traction; D021801:Zygapophyseal Joint / Q000293:injuries / Q000601:surgery*