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Spine
Diagnosis
Trauma
Vertebral Column, Discs, and Paraspinal Muscle
Atlantoaxial Rotatory Fixation
Atlantoaxial Rotatory Fixation
Jeffrey S. Ross, MD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Atlantoaxial rotatory fixation (AARF)

            • Synonyms

              • Atlantoaxial rotatory subluxation, rotary subluxation

            • Definitions

              • 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

                                    1. 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
                                    2. Spiegel D et al: Atlantoaxial rotatory displacement in children. World J Orthop. 8(11):836-45, 2017
                                    3. Neal KM et al: Atlantoaxial rotatory subluxation in children. J Am Acad Orthop Surg. 23(6):382-92, 2015
                                    4. Beier AD et al: Rotatory subluxation: experience from the Hospital for Sick Children. J Neurosurg Pediatr. 9(2):144-8, 2012
                                    5. 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
                                    6. Pang D: Atlantoaxial rotatory fixation. Neurosurgery. 66(3 Suppl):161-83, 2010
                                    7. 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
                                    8. 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
                                    9. 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
                                    10. 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
                                    11. Ghanem I et al: Pediatric cervical spine instability. J Child Orthop. 2(2):71-84, 2008
                                    12. 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
                                    13. 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
                                    14. 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
                                    15. Lustrin ES et al: Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics. 23(3):539-60, 2003
                                    16. Fielding JW et al: Atlantoaxial rotary deformities. Orthop Clin North Am. 9(4):955-67, 1978
                                    17. 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
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Pathology

                                          • Clinical Issues

                                            • Diagnostic Checklist

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Atlantoaxial rotatory fixation (AARF)

                                              • Synonyms

                                                • Atlantoaxial rotatory subluxation, rotary subluxation

                                              • Definitions

                                                • 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

                                                                      1. 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
                                                                      2. Spiegel D et al: Atlantoaxial rotatory displacement in children. World J Orthop. 8(11):836-45, 2017
                                                                      3. Neal KM et al: Atlantoaxial rotatory subluxation in children. J Am Acad Orthop Surg. 23(6):382-92, 2015
                                                                      4. Beier AD et al: Rotatory subluxation: experience from the Hospital for Sick Children. J Neurosurg Pediatr. 9(2):144-8, 2012
                                                                      5. 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
                                                                      6. Pang D: Atlantoaxial rotatory fixation. Neurosurgery. 66(3 Suppl):161-83, 2010
                                                                      7. 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
                                                                      8. 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
                                                                      9. 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
                                                                      10. 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
                                                                      11. Ghanem I et al: Pediatric cervical spine instability. J Child Orthop. 2(2):71-84, 2008
                                                                      12. 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
                                                                      13. 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
                                                                      14. 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
                                                                      15. Lustrin ES et al: Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics. 23(3):539-60, 2003
                                                                      16. Fielding JW et al: Atlantoaxial rotary deformities. Orthop Clin North Am. 9(4):955-67, 1978
                                                                      17. 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