title: Atlantoaxial Rotatory Fixed Dislocation: Report on a Series of 32 Pediatric Cases.
abstract: METHODS
  Retrospective case series of atlantoaxial rotatory fixed dislocation (AARFD).
  
  
  OBJECTIVE
  To describe clinical features and the surgical treatment of AARFD.
  
  
  BACKGROUND
  The classification and treatment strategy for atlantoaxial rotatory fixation (AARF) were previously described and remained controversial. AARF concomitant with atlantoaxial dislocation has different clinical features and treatment strategy with the most AARF. Due to deficiency of the transverse ligament or odontoid, the atlantoaxial remains unstable even after the torticollis relieved or cured. Because of the rarity, treatment strategy for this special condition has not been specialized and fully explored in the literatures.
  
  
  METHODS
  Thirty-two children with AARFD (sustained torticollis more than 6 weeks and atlanto-dental internal more than 5 mm) were retrospectively reviewed. Treatment methodology, pearls, and pitfalls of the treatment were discussed.
  
  
  RESULTS
  Thirty-two cases had sustained torticollis for an average of 5.7 months. ADI of them ranged from 8 to 22 mm, with a mean of 11.3 mm. Eight cases presented with signs and symptoms of spinal cord dysfunction. All 32 cases underwent surgery and had no spinal cord or vertebral artery injury. The surgery included posterior reduction and fusion (reducible dislocation and torticollis, 16 cases), and transoral release followed by posterior reduction and fusion (irreducible dislocation and torticollis, 16 cases). The average follow-up time was 42 months. Solid fusion and torticollis healing were achieved in 31 patients (96.9%) as detected radiologically. Two cases (6.3%, 2/32) suffered complications (cerebrospinal fluid leakage and recurred torticollis followed by revision).
  
  
  CONCLUSIONS
  AARFD had distinct clinical features relative to common presentations of AARF. Because of deficiency of the transverse ligament or odontoid and subsequent atlantoaxial dislocation, surgical treatments are applied for this condition, including transoral release and posterior C1-2 reduction and fusion. AARFD cases were successfully managed surgically without preoperative traction, with few complications seen.
  
  
  METHODS
  4.
authors.affiliation: Orthopaedic Department, Peking University Third Hospital, Beijing, China.
authors.forename: Shenglin
authors.initials: S
authors.lastname: Wang
authors.affiliation: Orthopaedic Department, Peking University Third Hospital, Beijing, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Yan
authors.affiliation: Division of Spinal Surgery, NYU Medical Center/Hospital for Joint Diseases, NYU school of Medicine, New York, NY.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
authors.affiliation: Orthopaedic Department, Peking University Third Hospital, Beijing, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging* / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D058028:Research Report; D012189:Retrospective Studies