Traumatic bilateral atlantoaxial rotatory subluxation mimicking as torticollis in an adult female

Abstract

Rotatory subluxation of the atlantoaxial joint in adults is a rare, but potentially life-threatening injury. Delayed or missed diagnosis can lead to catastrophic consequences. Early recognition and prompt treatment is paramount to avoid long-term morbidity and disability. We report on an instance of bilateral atlantoaxial rotatory subluxation (AARS) in a 25-year-old female who presented to the Casualty Department with a painful neck, right-sided hemiparesis and torticollis after a road traffic collision. Reduction was achieved by controlled cervical traction followed by immobilization in a four-post Halo brace, with complete resolution of her symptoms. At the 12-month follow-up, she had normal neck movements with no signs of instability.

Introduction

Atlantoaxial rotatory subluxation (AARS) is characterized by incomplete dislocation of the inferior atlantal and superior axial articular facets, and is usually reducible.¹ Conservative treatment is usually successful, but occasionally may require open reduction if diagnosis is delayed.² It is primarily seen in the pediatric population, and is rare in adults.³ Patients typically present with painful torticollis and a characteristic ‘cock robin’ position, with only few cases reported so far.³ Due to its rarity, it is usually overlooked, leading to incorrect diagnosis and management.⁴ The current case is a good example of post-traumatic AARS in an adult that was treated successfully by conservative means.