The Treatment of Traumatic Atlantoaxial Rotatory Subluxation (Fielding Type I) and the Correlation between the Clinical Progress and Radiological Reduction Parameter

ABSTRACT

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We will discuss clinical outcomes of adult traumatic atlantoaxial rotatory subluxation (Fielding type I) and verify the correlation between the clinical outcomes and radiological reduction rate. SUMMARY OF LITERATURE REVIEW Atlantoaxial rotatory subluxation which usually occur in children by non-traumatic sources or minor trauma has been discussed persistently. However, studies of atlantoaxial rotatory subluxation which occur in adults over 20 years old, especially by traumatic injury is rare. MATERIALS AND METHODS: From October 2004 to April 2011, thirty patients diagnosed of traumatic atlantoaxial rotatory subluxation with 6 months follow-up period were enrolled in the study. After diagnosis, we started treating Halter traction with 5 lbs. We discontinued traction when the patient recovered over 90% of ROM and applied Philadelphia collar to the patient. We measured visual analogue scale (VAS) for cervical pain and ROM. We measured atlanto-dens interval (ADI) and lateral mass-dens interval (LDI) difference using three-dimensional computed tomography (3D-CT) to validate radiological reduction rate. RESULTS: At the end of follow-up, none of the patients complained over pain and all recovered to full ROM. ADI was in normal range during the whole treatment period. LDI difference gradually decreased during treatment period, however, only 8 cases (26.7%) came back to normal range. CONCLUSIONS: In traumatic atlantoaxial rotatory subluxation (Fielding type I), satisfactory clinical outcomes such as pain relief or ROM improvement using traction and the radiological reduction rate was also improved but it failed to achieve a complete reduction of LDI difference in radiography.