Surgical management of adult traumatic atlantoaxial rotatory subluxation with unilateral locked facet; Case report and literature review

ABSTRACT

Atlantoaxial rotatory subluxation [AARS] is rarely occurred in adults with trauma as the most common cause. In type A and B it is usually managed with close reduction and external brace; however, in nonresponsive cases, surgical interventions might be needed. Our patient is a 21-year-old man with neck pain and torticollis after a car turn- over. There was C1-C2 rotatory subluxation with left side locked facet and C1 rotation about 40 degrees relative to C2 on computed tomography without evident of ligamentous injury in magnetic resonance imaging [MRI]. However, during the first 48 hours, two tries of close reduction using Gardner cervical traction under fluoroscopy were failed. Thus, the patient underwent open reduction of the subluxation and atlantoaxial fixation [Harm’s technique] with subsequent relief of pain and torticollis. This a rare case of traumatic AARS type A with unilateral locked facet joint in an adult patient which needed surgical manipulation for reduction. The management of the AARS in adults should be individualized in each patient