Abstract
Purpose
Atlantoaxial rotatory fixation and atlantoaxial rotatory subluxation are the most frequent manifestations of atlantoaxial rotatory dislocation (AARD) in pediatric population and are often treated conservatively. The objective of this study is to correlate the changes highlighted on MRI T2-weighted and STIR sequences with the duration of conservative treatment.
Methods
We analyzed nine consecutive patients treated surgically between 1 Jan 2006 and 1 Jan 2010 at the Policlinico Umberto I of Rome. All patients underwent cervical X-ray, computed tomography and magnetic resonance imaging (MRI) (T1 and T2-weighted, STIR, angio MRI). All patients were treated with bed rest, muscle relaxants and cervical collar, and radiological follow-up with MRI and cervical X-ray was performed.
Results
According to Fielding’s classification, we observed seven patients with a type 1 subluxation and two patients with a type II subluxation. In type 1, STIR and T2 sequences showed a hyperintensity in the alar and capsular ligaments and in the posterior ligamentous system, with integrity of the transverse ligament (LTA). In type 2, the hyperintensity also involved the LTA. During the follow-up, MRI showed a progressive reduction until the disappearance of the hyperintensity described, which was followed by a break with orthotic immobilization.
Conclusions
MRI with STIR sequences appears to be useful in addressing the duration of conservative treatment in AARD.
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References
Bilston LE, Brown J (2007) Pediatric spinal injury type and severity are age and mechanism dependent. Spine (Phila Pa 1976) 32(21):2339–2347
Dvorak J, Hayek J, Zehnder R (1987) CT-functional diagnostic of the rotatory instability of the upper cervical spine. Part 2: an evaluation on healthy adults and patients with suspected instability. Spine (Phila Pa 1976) 12(8):726–731
Fielding JW, Hawkins RJ (1977) Atlanto-axial rotator fixation (fixed rotatory subluxation of the atlantoaxial joint). J Bone Joint Surg Am 59:37–44
Givens TG, Polley KA, Smith GF et al (1996) Pediatric cervical spine injury: a three-year experience. J Trauma 41:310–314
Hadley MN, Zabramski JM, Browner CM et al (1988) Pediatric spinal trauma: review of 122 cases of spinal cord and vertebral column injuries. J Neurosurg 68:18–24
Heffez DS, Ducker TB (1995) Fractures and dislocations of the pediatric spine. In: Pang D (ed) Disorders of the pediatric spine. Raven Press, New York, pp 517–529
Been HD, Kerkhoffs GMMJ, Maas M (2007) Suspected atlantoaxial rotatory fixation-subluxation. The value of multidetector computed tomography scanning under general anesthesia. Spine (Phila Pa 1976) 32(5):E163–E167
Hill SA, Miller CA, Kosnik EJ et al (1984) Pediatric neck injuries: a clinical study. J Neurosurg 60:700–706
Ishii K, Matsumoto M, Momoshima S, Watanabe K, Tsuji T, Takaishi H, Nakamura M, Toyama Y, Chiba K (2011) Remodeling of C2 facet deformity prevents recurrent subluxation in patients with chronic atlantoaxial rotatory fixation: a novel strategy for treatment of chronic atlantoaxial rotatory fixation. Spine (Phila Pa 1976) 36(4):E256–E262
Salinsky JP, Scuderi GJ, Crawford AH (2007) Occipito-atlanto-axial dissociation in a child with preservation of life: a case report and review of the literature. Pediatr Neurosurg 43:137–141
Smith JL, Ackerman LL (2009) Management of cervical spine injuries in young children: lessons learned. Report of 2 cases. J Neurosurg Pediatrics 4(1):64–73
Lakadamyali H, Tarhan NC, Ergun T, Cakir B, Agildere AM (2008) STIR sequence for depiction of degenerative changes in posterior stabilizing elements in patients with lower back pain. AJR Am J Roentgenol 191(4):973–979
Lustrin ES, Karakas SP, Ortiz AO, Cinnamon J, Castillo M, Vaheesan K, Brown JH, Diamond AS, Black K, Singh S (2003) Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics 23(3):539–560
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
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 rotator fixation: case report. J Neurosurg (6 Suppl Pediatrics)103:563–566
Powers B, Miller MD, Kramer RS et al (1979) Traumatic anterior atlanto-occipital dislocation. Neurosurgery 4:12–17
Roche CJ, King SJ, Dangerfield PH, Carty HM (2002) The atlanto-axial joint: physiological range of rotation on MRI and CT. Clin Radiol 57(2):103–108
Ruge JR, Sinson GP, McLone DG et al (1988) Pediatric spinal injury: the very young. J Neurosurg 68:25–30
Rahimi SY, Stevens EA, Yeh DJ, Flannery AM, Choudhri HF, Lee MR (2003) Treatment of atlantoaxial instability in pediatric patients. Neurosurg Focus 15(6):Clinical Pearl 1
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Landi, A., Pietrantonio, A., Marotta, N. et al. 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), 94–99 (2012). https://doi.org/10.1007/s00586-012-2216-0
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DOI: https://doi.org/10.1007/s00586-012-2216-0