Case reportTraumatic atlantoaxial rotatory subluxation (TAARS) in adults: A report of two cases and literature review
Introduction
Pure traumatic atlantoaxial rotatory instability is a rare entity in adults. A review of the English literature revealed 10 cases of bilateral,3, 4, 5, 6, 7, 8, 19, 20, 21, 22 and two cases of unilateral13, 27 traumatic atlantoaxial rotatory dislocation (TAARD) in adults since the first report in 1969 (Table 1). The terminology associated with traumatic rotatory injuries at the atlantoaxial level is somewhat confusing, and a clear distinction should be made between rotatory subluxation and rotatory dislocation, as the mechanics of injury and the optimum management may differ. In this report, we use the term atlantoaxial rotatory subluxation to define a partial and transient reducible displacement of the adjacent articular surfaces at this level.
Our purpose is to describe two cases of traumatic atantoaxial rotatory subluxation (TAARS), focussing on management, outcome and a review of the literature.
Section snippets
Case 1
A fit 20-year-old female restrained car driver was involved in a head-on collision at a speed of 70 mph. Information on the position of her neck prior to the impact was unobtainable although there had been no loss of consciousness. On transfer, she was back boarded and in a cervical collar with triple immobilisation. Her main complaint was of upper cervical spine pain and she did not complain of nausea or vertigo. On physical examination there was no obvious torticollis. There was
Discussion
The atlantoaxial joint primarily contributes to about 50% of axial neck rotation and the transverse and alar ligaments provide the majority of biomechanical ligamentous stability. The transverse ligament and facet joint capsule prevent anterior translation of C1 on C2. The alar ligaments connect the posterolateral apex of the odontoid with the lateral aspect of the foramen magnum bilaterally, mainly limiting anterior shift of the atlas on the odontoid and excessive rotation of C1 on C2 to 50°.9
Conclusion
This report describes two cases of pure traumatic atlantoaxial rotatory subluxation. The long-term outcome may depend not only on early anatomic reduction but also on ligamentous and, perhaps, neural (C2 root) integrity. Early investigations with MRI may allow precise evaluation of soft tissue integrity and help in distinguishing lesions that may result in sub-optimal long-term outcome despite of prompt anatomic reduction and immobilisation.
Consent
Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
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