Chronic Atlantoaxial Rotatory Subluxation in an Adult Following a Traumatic Event: A Case Report

Background Traumatic rotatory subluxation of the atlantoaxial joint is a rare but potentially life-threatening injury in adults. While acute cases have been shown to be managed successfully with closed reduction, chronic injuries in skeletally mature patients have rarely been reported.

Methods We present management of a 64-year-old female who presents 2.5 years after a traumatic cervical injury with neck pain and torticollis. Imaging revealed rotatory subluxation of C1–C2 without cord impingement. A focused appraisal of the reported literature was also performed.

Results Successful reduction was achieved with halo cervical traction, followed by definitive treatment with atlantoaxial arthrodesis.

Conclusions Cases of fixed, chronic C1–C2 rotatory subluxation after traumatic etiology may be amenable to closed reduction with skeletal traction and fusion.

Level of Evidence 4.

Clinical Relevance Chronic, post-traumatic atlantoaxial rotatory subluxation in the adult population is extremely rare, without a well-described treatment algorithm. The purpose of this case report is to highlight the reduction and fixation of someone with this injury.