Atlantoaxial Rotatory Dis 

Background 

• C12 subluxation or facet dislocation 
• Presents with kid with what looks like torticollis 
  • Congenital muscular torticollis –  
    • The spasm itself turns the head (so opposite side of chin) 
  • AARD 
    • The spasm is protective to prevent FURTHER rotation (so same side as chin) 

Pathophysiology 

• Ligamentous laxity 
  • TL intact 
  • TL ruptured 

Causes 

• Infection (25%) 
  • Grisel’s disease = AARD aftter URTI or retropharyngeal abscess 
• Trauma (25%) 
• Recent surgery (25%) 
• Idiopathic 
• Associated 
  • Down’s 
  • RA 
  • Tumours 
  • Congenital 

Classification 

• Type 1 – unilateral facet sublux intact TL (odontoid pivots) 
• Type 2 – unilateral facet sublux injured TL (one facet pivot point, one displaces 5mm) 
• Type 3 – bilateral anterior facet displacement >5mm 
• Type 4 – bilateral posterior displacement (dens fracture or hypoplasia) 

‘ 

Imaging 

• Dynamic CT is key 

Management 

• <1 week – Soft Collar 
  • Often spontaneously reduces 
• Persists > 1w/ spasm 2w – head halter (5lb), NSAIDs, Benzo, hard collar 3mo 
• Persists > 1mo/ failed hard collar 2w – halo traction and vest 3mo 
• Persists > 3mo/ failed Halo 2w – PSIF 

*try everything for 2 weeks, and if it doesn’t work, go to next step 

• Soft collar 
• Head halter, nsaids, benzo  
• Halo 
• PSIF