Overview
Atlantoaxial ankylosis refers to the abnormal fusion or restricted mobility between the atlas (C1) and axis (C2) vertebrae, often resulting from trauma, infection, or inflammatory conditions, leading to potential neurological compromise 134.Diagnosis
Clinical Presentation: Neck pain, limited neck mobility, neurological deficits (e.g., weakness, sensory loss) 13.
Physical Examination: Assess for abnormal head tilt, restricted rotation, and neurological signs 23.
Imaging Studies:
- CT/MRI: Essential for detailed assessment of bony and soft tissue abnormalities 12.
- Plain X-rays: Initial screening for bony alignment and fractures 12.
Special Considerations: Differentiate from benign torticollis and other causes of neck stiffness 23.Management
Surgical Intervention:
- Anterior Fixation: Combined triple C1-C2 fixation for complex fractures, including manual reduction 1.
- Posterior Fusion: Alternative approach for stabilization, particularly in cases with occipital-cervical diastasis 1.
Conservative Treatment:
- Manual Reduction: Under sedation for cases like rotary subluxation 3.
- Immobilization: Use of cervical collars or halo vest for stabilization 4.
Early Recognition and Treatment: Critical for conditions like Grisel's syndrome to prevent complications 4.Special Populations
Pediatrics: High clinical suspicion for atlantoaxial rotatory subluxation in children with neck pain and abnormal head posture 23.
Elderly: Increased risk of complex fractures requiring combined anterior and posterior fixation techniques 1.
Comorbidities: Management tailored based on underlying conditions affecting bone quality and healing 14.Key Recommendations
Early and Prompt Diagnosis: Essential for effective management of atlantoaxial conditions, particularly in pediatric patients 2 (Evidence: Strong).
Surgical vs Conservative Approach: Choose based on severity and complexity; anterior fixation with manual reduction can be effective for complex fractures 1 (Evidence: Moderate).
Manual Reduction Under Sedation: Recommended for managing rotary subluxation in children 3 (Evidence: Moderate).
Early Conservative Treatment for Grisel's Syndrome: Can lead to favorable outcomes if recognized early 4 (Evidence: Weak).References
1 Frati A, Cimatti M, Ileyassoff H, Capobianco M, Santoro A, Armocida D. Combined Anterior Odontoid Screw Fixation and C1-C2 Jefferson Fracture Anterior Fixation: A Step-by-Step Technical Note. World neurosurgery 2024. link
2 Kinon MD, Nasser R, Nakhla J, Desai R, Moreno JR, Yassari R et al.. Atlantoaxial Rotatory Subluxation: A Review for the Pediatric Emergency Physician. Pediatric emergency care 2016. link
3 Sobolewski BA, Mittiga MR, Reed JL. Atlantoaxial rotary subluxation after minor trauma. Pediatric emergency care 2008. link
4 Boiten J, Hageman G, de Graaff R. The conservative treatment of patients presenting with Grisel's syndrome. Clinical neurology and neurosurgery 1986. link80003-8)
5 Pick RY. Quadricepsplasty: a review, case presentations, and discussion. Clinical orthopaedics and related research 1976. link