A 30-year-old Male with Delayed Diagnosis and Management of Chronic Post-traumatic Atlantoaxial Rotatory Subluxation

INTRODUCTION: Atlantoaxial rotatory subluxation (AARS) is an uncommonly encountered diagnosis within the adult population. The rare nature of this dislocation within the adult population often results in delayed diagnosis and treatment. CASE REPORT: A 30-year-old male presented following a low-speed motor vehicle accident. The patient had been involved in a work-related accident 1-year prior and had experienced fixed leftward gaze and tenderness of the cervical spine following this incident, but exhibited no focal neurologic deficits. Imaging demonstrated a Fielding Type 1 AARS of approximately 45°. The subluxation was reduced; and posterior C1–C2 instrumentation and fusion were performed, with no complications. Post-operative imaging revealed maintained reduction and alignment. The patient regained acceptable alignment and relief from his pre-operative symptoms. CONCLUSIONS: Our case is an illustration of a chronic post-traumatic AARS in an adult patient with delayed diagnosis and definitive management. This diagnosis is rare within the adult population and is frequently overlooked. A high index of suspicion must exist when evaluating adult patients with clinical presentations of chronic neck pain, torticollis, or “cock robin” head positioning as delayed diagnosis.