Atlantoaxial facet locking: treatment by facet manipulation and fixation. Experience in 14 cases

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The authors report their experience with 14 children in whom acute torticollis or a fixed flexion neck deformity developed. Other than neck deformity, there was no other significant functional or neurological symptom. Although several possible pathogenetic factors have been speculated, the exact cause remains unknown. Conservative observation and/or attempts at closed reduction failed to effect deformity resolution. Investigations revealed “locking” of facets that resulted in rotatory or translatory atlantoaxial dislocation depending on the nature of facet dislocation. The management issues in such cases are evaluated. The authors discuss the validity of atlantoaxial facet distraction and manipulation/reduction and fixation under direct visualization. In all cases recovery from neck deformity was significant immediately after surgery. The deformity resolution was sustained during a mean follow-up period of 23 months (range 3–52 months), although the range of neck movements remained marginally restricted. The craniovertebral realignment is demonstrated by images and clinical photographs.

Article Information

Address correspondence to: Atul Goel, M.Ch., Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai 400012, India. email: atulgoel62@hotmail.com.

Please include this information when citing this paper: published online December 17, 2010; DOI: 10.3171/2010.9.SPINE1010.

© AANS, except where prohibited by US copyright law.

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Figures

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    A: Photograph of a 5-year-old girl with marked torticollis. B: Axial CT reconstructions showing partial rotatory dislocation. The facet joint of the atlas on one side acts as a pivot and the contralateral side of the facet is anteriorly dislocated. The process results in a rotatory dislocation. C: Coronal CT reconstruction demonstrating the atlantoaxial facets on one side in alignment, whereas on the contralateral side the atlantal facet is not aligned to the axial facet. D: Sagittal image showing the dislocation of the facet of atlas over the facet of axis. E: Three-dimensional CT reconstruction revealing rotatory atlantoaxial dislocation. F: Postoperative axial CT reconstructions showing the implant and the realignment of the facets. G: Coronal image demonstrating the atlantal and axial facets in normal alignment. H: Image showing plate and screw fixation of the atlantoaxial region and the facet realignment. I: Photograph showing the neck in a normal position.

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    A: Photograph of a 9-year-old boy with torticollis. B: Sagittal CT reconstruction revealing the location of the odontoid process in relationship to the arch of the atlas. C: Three-dimensional CT reconstruction showing complete rotatory atlantoaxial dislocation. The facet of atlas is anterior to the facet of axis on one side and posterior to it on the other side. D: Axial CT reconstruction demonstrating complete rotatory atlantoaxial dislocation. E: Coronal CT reconstruction showing the malalignment. F: Sagittal image showing the dislocation of the facet of atlas over the facet of axis. G: Postoperative scan showing the position of the odontoid process in relationship to the arch of atlas. H: Axial scan showing the implant and the facet realignment. I: Coronal image showing the facets in alignment. J: Sagittal image showing the facets of atlas and axis in alignment. K: Postoperative photograph showing the neck of the patient in good position.

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    A: Lateral radiograph obtained in a 12-year-old boy showing translatory dislocation. The C-1 vertebra is dislocated anteriorly. B: Three-dimensional CT reconstruction revealing the translatory dislocation of C-1 over C-2. C: Sagittal image showing the dislocation of the C-1 facet over the C-2 facet. D: Axial image showing the facets of the atlas on both sides dislocated anterior to the facets of the axis. E: Coronal image demonstrating the atlantoaxial malalignment. F: Photograph of the boy holding his head with thumb over the chin to look ahead. G: Sagittal image showing the fixation and the realignment of the facets. H: Axial image showing the reduction of dislocation and fixation. I: Coronal image showing the fixation and the reduction.

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