Rotatory fixation or subluxation: Persistent rotational deformity of C1-C2 complex with resultant torticollis and head in cock-robin position; normal atlantodental interval (ADI)
Rotatory dislocation: More severe injury with anterior displacement of lateral mass of C1 relative to C2 with widening of ADI
IMAGING
General Features
Radiographic Findings
CT Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Henderson FC Sr et al: Atlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization. Neurosurg Rev. ePub, 2020
Spiegel D et al: Atlantoaxial rotatory displacement in children. World J Orthop. 8(11):836-45, 2017
Neal KM et al: Atlantoaxial rotatory subluxation in children. J Am Acad Orthop Surg. 23(6):382-92, 2015
Beier AD et al: Rotatory subluxation: experience from the Hospital for Sick Children. J Neurosurg Pediatr. 9(2):144-8, 2012
Landi A 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:S94-9, 2012
Pang D: Atlantoaxial rotatory fixation. Neurosurgery. 66(3 Suppl):161-83, 2010
Heuer GG et al: Treatment of pediatric atlantoaxial instability with traditional and modified Goel-Harms fusion constructs. Eur Spine J. 18(6):884-92, 2009
Pharisa C et al: Neck complaints in the pediatric emergency department: a consecutive case series of 170 children. Pediatr Emerg Care. 25(12):823-6, 2009
Pieretti-Vanmarcke R et al: Clinical clearance of the cervical spine in blunt trauma patients younger than 3 years: a multi-center study of the American Association for the Surgery of Trauma. J Trauma. 67(3):543-9; discussion 549-50, 2009
Rojas CA et al: Evaluation of the C1-C2 articulation on MDCT in healthy children and young adults. AJR Am J Roentgenol. 193(5):1388-92, 2009
Ghanem I et al: Pediatric cervical spine instability. J Child Orthop. 2(2):71-84, 2008
Ishii K et al: Pathognomonic radiological signs for predicting prognosis in patients with chronic atlantoaxial rotatory fixation. J Neurosurg Spine. 5(5):385-91, 2006
Pang D et al: 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):954-72; discussion 954-72, 2005
Pang D et al: Atlantoaxial rotatory fixation: part 1--biomechanics of normal rotation at the atlantoaxial joint in children. Neurosurgery. 55(3):614-25; discussion 625-6, 2004
Lustrin ES et al: Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics. 23(3):539-60, 2003
Fielding JW et al: Atlantoaxial rotary deformities. Orthop Clin North Am. 9(4):955-67, 1978
Fielding JW et al: Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am. 59(1):37-44, 1977
Rotatory fixation or subluxation: Persistent rotational deformity of C1-C2 complex with resultant torticollis and head in cock-robin position; normal atlantodental interval (ADI)
Rotatory dislocation: More severe injury with anterior displacement of lateral mass of C1 relative to C2 with widening of ADI
IMAGING
General Features
Radiographic Findings
CT Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
Staging, Grading, & Classification
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Henderson FC Sr et al: Atlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization. Neurosurg Rev. ePub, 2020
Spiegel D et al: Atlantoaxial rotatory displacement in children. World J Orthop. 8(11):836-45, 2017
Neal KM et al: Atlantoaxial rotatory subluxation in children. J Am Acad Orthop Surg. 23(6):382-92, 2015
Beier AD et al: Rotatory subluxation: experience from the Hospital for Sick Children. J Neurosurg Pediatr. 9(2):144-8, 2012
Landi A 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:S94-9, 2012
Pang D: Atlantoaxial rotatory fixation. Neurosurgery. 66(3 Suppl):161-83, 2010
Heuer GG et al: Treatment of pediatric atlantoaxial instability with traditional and modified Goel-Harms fusion constructs. Eur Spine J. 18(6):884-92, 2009
Pharisa C et al: Neck complaints in the pediatric emergency department: a consecutive case series of 170 children. Pediatr Emerg Care. 25(12):823-6, 2009
Pieretti-Vanmarcke R et al: Clinical clearance of the cervical spine in blunt trauma patients younger than 3 years: a multi-center study of the American Association for the Surgery of Trauma. J Trauma. 67(3):543-9; discussion 549-50, 2009
Rojas CA et al: Evaluation of the C1-C2 articulation on MDCT in healthy children and young adults. AJR Am J Roentgenol. 193(5):1388-92, 2009
Ghanem I et al: Pediatric cervical spine instability. J Child Orthop. 2(2):71-84, 2008
Ishii K et al: Pathognomonic radiological signs for predicting prognosis in patients with chronic atlantoaxial rotatory fixation. J Neurosurg Spine. 5(5):385-91, 2006
Pang D et al: 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):954-72; discussion 954-72, 2005
Pang D et al: Atlantoaxial rotatory fixation: part 1--biomechanics of normal rotation at the atlantoaxial joint in children. Neurosurgery. 55(3):614-25; discussion 625-6, 2004
Lustrin ES et al: Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics. 23(3):539-60, 2003
Fielding JW et al: Atlantoaxial rotary deformities. Orthop Clin North Am. 9(4):955-67, 1978
Fielding JW et al: Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am. 59(1):37-44, 1977
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