Traumatic Chronic Irreducible Atlantoaxial Rotatory Fixation in Adults: Review of the Literature, With Two New Examples

ABOLFAZL RAHIMIZADEH; WALTER WILLIAMSON; SHAHAYEGH RAHIMIZADEH

doi:10.14444/6048

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Figure 1
(a) Lateral cervical radiograph: shows rotation of atlas and demonstrating foramen transversarium indicating rotation of atlas. (b) Axial computed tomography (CT) scan: demonstrated deviation of odontoid toward right lateral mass of atlas. (c) Axial CT scan showing the lateral mass of C1 in front of C2 lateral mass (white arrow). (d) Reconstructed 3D CT image showing backward displacement of right C1 lateral mass (white arrow) and forward displacement of left C1 lateral mass; note deviation of the posterior arch of atlas to left (black arrow). (e) Intraoperative view: demonstrating transverse rod technique. Note deviated spinal process of C1 (black arrow) with respect to C2 spinal process. Forward displacement of C1 lateral mass is also observed. (f) Intraoperative view shows switching to C1-C2 screw rod fixation on the left side. (g) Postoperative x-ray shows C1-C2 screw–rod hook fixation.
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Figure 2
(a) The patient's photograph showing typical Cock–Robin posture. (b) Axial computed tomography (CT) scan demonstrating deviation of the odontoid to the right lateral mass of C1, as well as rotation of atlas. (c) Coronal reconstructed CT scan showing displacement of odontoid toward the lateral mass of C1 and forward displacement of C1 lateral mass. Right C1 lateral mass is gradually going backward and disappearing in these images. (d) Lateral cervical spine x-ray with the patient under cranial traction; note the corpectomy of C5, replacement with expandable cage secured with plate. Rotation of the atlas and foramen transversarium is evident. (e) Intraoperative view, showing transverse screw rod construct. (f) Intraoperative view shows final C1-C2 screw rod Harms technique. (g) Postoperative patient's photographs demonstrating the patient a day after surgery being happy with correction of torticollis. (h) Postoperative lateral cervical radiograph demonstrating proper C1-C2 fixation.
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Figure 3
Transverse rod technique in plastic model, (a) C1-C1 rod construct is pulled cranially and C2-C2 construct caudally, (b) C1-C2 fixation after reduction with Harms' technique.