Highlights
- •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.
Abstract
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.
Keywords
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References
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Article info
Publication history
Published online: March 13, 2020
Accepted:
March 9,
2020
Received:
January 8,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
