Doing More with LessManagement of Pediatric Atlantoaxial Rotatory Subluxation with a Simple Handmade Cervical Traction Device: Doing More with Less
Introduction
The atlantoaxial (C1–C2) joint accounts for up to two thirds of instances of total axial craniocervical rotations to either side. Its major role in the pivotal rotation of the cervical spine makes it more vulnerable to a certain type of injury known as atlantoaxial rotatory subluxation (AARS). Rotatory subluxation of this joint is more prevalent in the pediatric age group.1 Although infections are the most common cause in the pediatric age group (known as Grisel syndrome),2 most cases of AARS in adults occur after trauma with injury to the transverse or alar ligaments or both.3, 4, 5 The most common presentation of AARS is torticollis, which is described as the “cock-robin” position of the neck, followed by suboccipital headache.
The management of AARS is based on the Fielding classification.6 Accordingly, patients with stable classes (I and II) can be treated with closed reduction and immobilization, whereas patients with unstable classes (III and IV) and those with neurologic deficits attributable to the injury should be treated with reduction and C1–C2 fusion.6 Regardless of the duration of symptoms and the type of AARS, benzodiazepines, muscle relaxants, steroids, and cervical traction are the primary constituents of treatment for achieving reduction. Better outcomes with the management of AARS in the acute stage show that early diagnosis and management of AARS merits certain attention. In areas with unavailable resources, a simple design of a traction device can be a reasonable substitute for halter traction for the management of AARS.1, 7
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Case Report
A 9-year-old girl was referred from a rural center in southern Iran 3 weeks after she was in a car accident. She described having painful torticollis, and on physical examination her head was rotated to the right and laterally flexed to the left in the typical “cock-robin” posture. However, the results of her neurologic examination were unremarkable. Thin-cut computed tomographic (CT) scans showed type I atlantoaxial rotatory subluxation according to the Fielding classification6 (Figure 1).
With
Discussion
AARS is quite common in the pediatric age group.1 Upper respiratory tract infection (Grisel syndrome), trauma, and iatrogenic factors are the most common causes.2 The management of AARS is based on the Fielding classification and consists of closed reduction with a cervical traction device and stabilization.6 Several cervical traction devices are available for this purpose, including the Gardner-Wells tongs and the halter traction device.7 All the available devices require the insertion of pins
References (7)
- et al.
Grisel syndrome following adenoidectomy: Surgical management in a case with delayed diagnosis
World Neurosurg
(2015) - et al.
Traumatic atlantoaxial rotatory subluxation (TAARS) in adults: A report of two cases and literature review
Injury
(2012) - et al.
Spinal cord injury in parkour sport (free running): A rare case report
Chin J Traumatol
(2014)
Cited by (2)
Halter Traction for the Treatment of Atlantoaxial Rotatory Fixation
2022, Journal of Bone and Joint Surgery
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.