- •We report a case of atlantoaxial rotatory fixation in an adult with spastic torticollis.
- •Surgical treatment for atlantoaxial rotatory fixation in an adult should be considered if the diagnosis is delayed.
- •The possibility of revealing spastic torticollis after existing AARF surgery should be considered.
- •Appropriate treatment for spastic torticollis applied after surgery resulted in a favorable outcome.
Atlantoaxial rotatory fixation (AARF) in an adult without any trauma is an extremely rare condition. Here we report a case of surgical treatment for existing atlantoaxial rotatory fixation in an adult with spastic torticollis. A 50-year-old man had become aware of torticollis without any cause of injury 6 weeks before he visited our hospital, where he presented with a one-week history of severe neck pain. Based on the local and imaging findings, we diagnosed him as having existing AARF of Fielding classification type I. The AARF was not reduced by 3 weeks of Glisson traction. Thus, we performed C1–C2 posterior fusion surgery 3 months after his initial visit. Although CT findings just after surgery showed that the C1-2 facet subluxation was reduced, the complaint of torticollis was not improved, with scoliosis at the middle to lower cervical level because of left sternocleidomastoid hypertonia. Administration of diazepam was initiated 2 weeks after surgery and botulinum toxin injections to the left sternocleidomastoid were added 2 months after surgery under the neurological diagnosis of spastic torticollis. As a result, the complaint of his torticollis was significantly improved 3 months after surgery. There were no relapses of the torticollis and complete fusion of the C1–C2 laminae was observed at the 2-year final follow-up. Surgical treatment for AARF in an adult should be considered if the diagnosis of AARF is delayed. In addition, appropriate treatment for spastic torticollis applied after surgery resulted in a favorable outcome of this case.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Clinical Neuroscience
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Adult traumatic atlantoaxial rotatory fixation: a case report.Case Rep Orthop. 2014; 2014593621
- Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint).J Bone Joint Surg Am. 1977; 59: 37-44
- Torticollis due to atlantoaxial rotatory fixation.J Clin Neurosci. 2008; 15: 316-318
- Atlantoaxial rotatory fixation in adults patient.J Korean Neurosurg Soc. 2009; 45: 246-248
- A 24-year-old woman with neck pain.Am J Emergency Med. 2011; 29: e1-e2
- Spontaneous atlantoaxial rotatory fixation in old age after cerebral infarction: case report.Spine. 2000; 25: 2137-2140
- Therapeutic options and results following fixed atlantoaxial rotatory dislocations.Eur Spine J. 2005; 14: 61-68
Published online: March 13, 2020
Accepted: March 9, 2020
Received: January 8, 2020
© 2020 Elsevier Ltd. All rights reserved.