Chronic C1-C2 Rotatory Subluxation Reduced by C1 Lateral Mass Screws and C2 Translaminar Screws: A Case Report.
BACKGROUND
C1-C2 rotatory subluxation can result from a variety or etiologies. Pediatric patients are particularly susceptible to C1-C2 rotatory subluxation. If left untreated the condition is termed an atlantoaxial rotatory fixation (AARF) and chronic neck pain and deformity can result. Patients failing conservative treatment or those with recurrent or chronic rotatory subluxation may require halo treatment or surgical intervention. This illustrative case report is about a patient with chronic C1-C2 AARF who was treated with C1 lateral mass screws and C2 translaminar screws, a treatment that has not been addressed by this technique in a pediatric population.


METHODS
This is a retrospective case review.


RESULTS
After an unsuccessful attempt at reduction, an 11-year-old girl underwent surgery to treat her C1-C2 AARF. Through an all posterior approach, screws were placed bilaterally into the C1 lateral masses followed by the placement of C2 translaminar screws bilaterally. A small amount of distraction was applied through the screw construct to open up the C1-C2 articulation and the AARF was open reduced and fused. A detailed postoperative computed tomographic scan focused on the occiput C1-C2 joint confirmed the anatomical reduction of the joint complex.


CONCLUSIONS
The patient had cosmetically pleasing relief of her torticollis and was doing well at 60 months after surgery.


METHODS
Level IV.
*Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY †Sir HN Reliance Foundation Hospital, Mumbai, India.
William F
WF
Lavelle
Kathryn
K
Palomino
Siddharth A
SA
Badve
Stephen A
SA
Albanese
D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D059350:Chronic Pain; D000072700:Conservative Treatment; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D019547:Neck Pain; D011184:Postoperative Period; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D014103:Torticollis / Q000601:surgery