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Closed manual reduction maneuver of atlantoaxial rotatory dislocation in pediatric age

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Abstract

Purpose

The purposes of this study were to characterize the clinical and radiological features of type 1 and type 2 atlantoaxial rotatory dislocations (AARD) and to evaluate the outcome of the manual reduction maneuver for these types of dislocations in pediatric patients.

Methods

This study considered 12 pediatric patients with AARD who were treated between January 2003 and March 2013. The diagnosis was established by clinical findings and 3D-CT. All of the patients were treated by closed manual reduction and then a cervical orthosis was performed. All of the patients were followed up at regular intervals.

Results

The causes of the AARD were trauma (91.67 %) and infection (8.33 %). The time between onset of symptoms and admission to the hospital ranged from 16 days to 6 months. In radiological evaluation, the mean rotational angulation of the patients was 30.58°. The 3D-CT examination showed that six patients (50 %) had type 1 dislocation and six patients (50 %) had type 2 dislocation. All of the patients were treated by closed manual reduction and then a cervical orthosis was performed. For 11 patients (91.67 %), dislocation was successfully reducted and maintained. One patient (8.33 %) underwent surgery, following recurrence of the second closed reduction maneuver.

Conclusion

This preceding treatment method has successfully produced a fast and recurrence-free alignment on all except one of our patients. This technique can be a useful treatment alternative in carefully selected AARD cases. Future research is encouraged to improve decision making in the application of this treatment method and provide additional validation of the current findings.

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References

  1. Ballock RT, Song KM (1996) The prevalence of nonmuscular causes of torticollis in children. J Pediatr Orthop 16(4):500–504

    Article  CAS  PubMed  Google Scholar 

  2. Been HD, Kerkhoffs GM, Maas M (2007) Suspected atlantoaxial rotatory fixation-subluxation: the value of multidetector computed tomography scanning under general anesthesia. Spine (Phila Pa 1976) 1;32(5):E163–E167

    Article  Google Scholar 

  3. Beier AD, Vachhrajani S, Bayerl SH, Aguilar CY, Lamberti Pasculli M, Drake JM (2012) Rotatory subluxation: experience from the Hospital for Sick Children. J Neurosurg Pediatr 9(2):144–148

    Article  PubMed  Google Scholar 

  4. Bono CM, Vaccaro AR, Fehlings M, Fisher C, Dvorak M, Ludwig S, Harrop J (2007) Spine Trauma Study Group. Measurement techniques for upper cervical spine injuries: consensus statement of the Spine Trauma Study Group. Spine (Phila Pa 1976) 1;32(5):593–600

    Article  Google Scholar 

  5. Casey AT, O'Brien M, Kumar V, Hayward RD, Crockard HA (1995) Don't twist my child's head off: iatrogenic cervical dislocation. BMJ 4;311(7014):1212–1213

    Article  Google Scholar 

  6. Crook TB, Eynon CA (2005) Traumatic atlantoaxial rotatory subluxation. Emerg Med J 22(9):671–672

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Fielding JW, Hawkins RJ, Ratzan SA (1976) Spine fusion for atlanto-axial instability. J Bone Joint Surg Am 58(3):400–407

    CAS  PubMed  Google Scholar 

  8. Fielding JW, Hawkins RJ (1977) Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am 59(1):37–44

    CAS  PubMed  Google Scholar 

  9. Ghanem I, El Hage S, Rachkidi R, Kharrat K, Dagher F, Kreichati G (2008) Pediatric cervical spine instability. J Child Orthop 2(2):71–84

    Article  PubMed Central  PubMed  Google Scholar 

  10. Inamasu J, Guiot BH (2006) Vertebral artery injury after blunt cervical trauma: an update. Surg Neurol 65(3):238–245

    Article  PubMed  Google Scholar 

  11. Kowalski HM, Cohen WA, Cooper P, Wisoff JH (1987) Pitfalls in the CT diagnosis of atlantoaxial rotary subluxation. AJR Am J Roentgenol 149(3):595–600

    Article  CAS  PubMed  Google Scholar 

  12. Landi A, Pietrantonio A, Marotta N, Mancarella C, Delfini R (2012) Atlantoaxial rotatory dislocation (AARD) in pediatric age: MRI study on conservative treatment with Philadelphia collar—experience of nine consecutive cases. Eur Spine J 21(Suppl 1):S94–S99

    Article  PubMed  Google Scholar 

  13. Lee SC, Lui TN, Lee ST (2002) Atlantoaxial rotatory subluxation in skeletally immature patients. Br J Neurosurg 16(2):154–157

    Article  CAS  PubMed  Google Scholar 

  14. Maile S, Slongo T (2007) Atlantoaxial rotatory subluxation: realignment and discharge within 48 h. Eur J Emerg Med 14(3):167–169

    Article  PubMed  Google Scholar 

  15. Meyer PR Jr (1997) Cervical spine fractures: changing management concepts. In: Bridwell KH, Dewald RL (eds) The textbook of spinal surgery. Lippincott Williams & Wilkins, Philadelphia, pp 1700–1704

    Google Scholar 

  16. Missori P, Miscusi M, Paolini S, DiBiasi C, Finocchi V, Peschillo S, Delfini R (2005) A C1-2 locked facet in a child with atlantoaxial rotatory fixation. Case report. J Neurosurg 103(6 Suppl):563–566

    PubMed  Google Scholar 

  17. Pang D, Li V (2004) Atlantoaxial rotatory fixation: part 1—biomechanics of normal rotation at the atlantoaxial joint in children. Neurosurgery 55(3):614–625

    Article  PubMed  Google Scholar 

  18. Pang D, Li V (2005) Atlantoaxial rotatory fixation: part 2—new diagnostic paradigm and a new classification based on motion analysis using computed tomographic imaging. Neurosurgery 57(5):941–953

    Article  PubMed  Google Scholar 

  19. Pang D, Li V (2005) Atlantoaxial rotatory fixation: part 3—a prospective study of the clinical manifestation, diagnosis, management, and outcome of children with alantoaxial rotatory fixation. Neurosurgery 57(5):954–972

    Article  PubMed  Google Scholar 

  20. Park SW, Cho KH, Shin YS, Kim SH, Ahn YH, Cho KG, Huh JS, Yoon SH (2005) Successful reduction for a pediatric chronic atlantoaxial rotatory fixation (Grisel syndrome) with long-term halter traction: case report. Spine (Phila Pa 1976) 1;30(15):E444–E449

    Article  Google Scholar 

  21. Phillips WA, Hensinger RN (1989) The management of rotatory atlanto-axial subluxation in children. J Bone Joint Surg Am 71(5):664–668

    CAS  PubMed  Google Scholar 

  22. Rahimi SY, Stevens EA, Yeh DJ, Flannery AM, Choudhri HF, Lee MR (2003) Treatment of atlantoaxial instability in pediatric patients. Neurosurg Focus 15:15(6)

    Article  Google Scholar 

  23. Richards PJ, George J, Metelko M, Brown M (2010) Spine computed tomography doses and cancer induction. Spine (Phila Pa 1976) 35(4):430–433

    Article  Google Scholar 

  24. Roche CJ, O’Malley M, Dorgan JC, Carty HM (2001) A pictorial review of atlanto-axial rotatory fixation: key points for the radiologist. Clin Radiol 56(12):947–958

    Article  CAS  PubMed  Google Scholar 

  25. Spivak JM, Afshin ER. (2003) Cervical traction and reduction techniques. In Vaccaro A. (Ed). Fractures of the cervical, thoracic, and lumbar spine. Marcel Dekker, New York, pp 283–299

  26. Subach BR, McLaughlin MR, Albright AL, Pollack IF (1998) Current management of pediatric atlantoaxial rotatory subluxation. Spine (Phila Pa 1976) 15;23(20):2174–2179

    Article  Google Scholar 

  27. Tolhurst SR, Vanderhave KL, Caird MS, Garton HL, Graziano GP, Maher CO, Hensinger RN, Farley FA (2013) Cervical arterial injury after blunt trauma in children: characterization and advanced imaging. J Pediatr Orthop 33(1):37–42

    Article  PubMed  Google Scholar 

  28. Tomczak KK, Rosman NP (2013) Torticollis. J Child Neurol 28(3):365–378

    Article  PubMed  Google Scholar 

  29. Tsai SW, Chou CS (2005) A case report of manipulation under anesthesia of posttraumatic type II occipital-atlantoaxial rotatory subluxation in a 4-year-old girl. J Manipulative Physiol Ther 28(5):352–355

    Article  PubMed  Google Scholar 

  30. Villas C, Arriagada C, Zubieta JL (1999) Preliminary CT study of C1-C2 rotational mobility in normal subjects. Eur Spine J 8(3):223–228

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Weisskopf M, Naeve D, Ruf M, Harms J, Jeszenszky D (2005) Therapeutic options and results following fixed atlantoaxial rotatory dislocations. Eur Spine J 14(1):61–68

    Article  PubMed Central  PubMed  Google Scholar 

  32. White Augustus A, Panjabi MM (1990) Clinical biomechanics of the spine, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, PA, pp 295–302

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, School of Medicine, University of Hacettepe, 06100, Sıhhiye, Ankara, Turkey

    Atilla Akbay, Burçak Bilginer & Nejat Akalan

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  1. Atilla Akbay
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  2. Burçak Bilginer
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  3. Nejat Akalan
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Correspondence to Atilla Akbay.

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Akbay, A., Bilginer, B. & Akalan, N. Closed manual reduction maneuver of atlantoaxial rotatory dislocation in pediatric age. Childs Nerv Syst 30, 1083–1089 (2014). https://doi.org/10.1007/s00381-013-2347-6

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  • DOI: https://doi.org/10.1007/s00381-013-2347-6

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