Traumatic atlantoaxial rotatory subluxation in adults – A case report and literature review

BACKGROUND: Traumatic atlantoaxial rotatory subluxation (AARS) is extremely rare in adult versus pediatric populations. Patients usually present with post-traumatic neck pain and torticollis. Surgical management aims at reducing the deformity and stabilizing the spine utilizing external orthotics, and/or internal reduction/fixation. METHODS: A 65-year-old female fell downstairs at home. She complained of neck pain with right-sided tenderness and torticollis. The radiographic studies and CT scan demonstrated AARS. This led to an emergent open reduction with internal fixation at the C1-C2 level. RESULTS: We identified 25 similar cases of AARS in the English literature. Patients averaged 28.7 years of age and mostly sustained motor vehicle accidents largely treated with traction/orthotics; only six patients required surgical open reduction/internal fixation. CONCLUSION: In this case, the patient’s C1-C2 deformity required open reduction/internal fixation rather than bracing alone.