Computerized tomographic demonstration of rotational atlanto-axial fixation

Case report

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✓ The authors report a case of rotational fixation of the atlanto-axial joint in which the diagnosis was not reached by conventional radiographic techniques. The clinical impression of rotational fixation was ultimately confirmed by computerized tomography. This new diagnostic modality can be very helpful in arriving at a very difficult diagnosis.

Article Information

Address reprint requests to: Italo Rinaldi, M.D., Hampton Roads Neurological Center, Inc., 11 Bruton Avenue, Newport News, Virginia 23601.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Lateral tomogram of the cervical spine, showing slight separation of the odontoid peg from the anterior arch of the atlas. Center: Anteroposterior tomogram of the atlanto-axial complex. There is no definite lateral offset of the articular masses from the odontoid. Right: Anteroposterior tomogram of the atlanto-axial complex in a slightly different projection revealing that the distance between the right lateral mass of the atlas and the odontoid is greater than the distance on the right side. Still there is no definite lateral offset.

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    Upper: Computerized tomography scanning through C-1 and C-2. Left: Scan with the face turned to the right as much as possible, showing the rotational subluxation. Note that the spinous process of C-1 is to the right of the spinous process of C-2. Right: When the face is maximally rotated to the left (occiput to the right, face to the left), the relative position of C-1 and C-2 remains unaltered, demonstrating the fixation of the rotational deformity. Note that the spinous process of C-1 is still to the right of the spinous process of C-2. Lower: Diagrammatic representation of scans showing the rotational subluxation of the articular masses and the fixation of C-1 and C-2.

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    Computerized tomography scanning through C-1 and C-2 in a normal patient. Left: Relative positions of C-1 and C-2 when the face is rotated to the left. Note that the spinous process of C-1 is to the right of the spinous process of C-2. Right: When the face is turned to the right, the spinous process of C-1 is to the left of the spinous process of C-2. Note the relative immobility of the axis when compared to the marked mobility of the atlas.

References

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