title: The treatment of refractory atlanto-axial rotatory fixation using a halo vest: results of a case series involving seven children.
abstract: We reviewed seven children with torticollis due to refractory atlanto-axial rotatory fixation who were treated in a halo vest. Pre-operative three-dimensional CT and sagittal CT imaging showed deformity of the superior articular process of C2 in all patients. The mean duration of halo vest treatment was 67 days (46 to 91). The mean follow-up was 34 months (8 to 73); at the latest review six patients demonstrated remodelling of the deformed articular process. The other child, who had a more severe deformity, required C1-2 fusion. We suggest that patients with atlanto-axial rotatory fixation who do not respond to conservative treatment and who have deformity of the superior articular process of C2 should undergo manipulative reduction and halo-vest fixation for two to three months to induce remodelling of the deformed superior articular process before C1-2 fusion is considered.
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya 466-8550, Japan. ryoji-t@med.nagoya-u.ac.jp
authors.forename: R
authors.initials: R
authors.lastname: Tauchi
authors.forename: S
authors.initials: S
authors.lastname: Imagama
authors.forename: T
authors.initials: T
authors.lastname: Kanemura
authors.forename: H
authors.initials: H
authors.lastname: Yoshihara
authors.forename: K
authors.initials: K
authors.lastname: Sato
authors.forename: M
authors.initials: M
authors.lastname: Deguchi
authors.forename: M
authors.initials: M
authors.lastname: Kamiya
authors.forename: N
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000293:injuries*; D001915:Braces; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D004204:Joint Dislocations / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D014057:Tomography, X-Ray Computed; D014103:Torticollis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome