I have no personal knowledge of theis entity, but a quick literature
search suggested that it does not always get better and some patients
apparently require traction or surgery. I have copied a section from a
textbook in my second message.


1) Current management of pediatric atlantoaxial rotatory subluxation.

Subach BR - Spine - 1998 Oct 15; 23(20): 2174-9

NLM Citation ID:

Author Affiliation:
Department of Neurological Surgery, Children's Hospital of Pittsburgh,
Pennsylvania, USA.

Subach BR; McLaughlin MR; Albright AL; Pollack IF

STUDY DESIGN: A retrospective clinical review of 20 children seen during
a 7-year period
who had atlantoaxial rotatory subluxation. OBJECTIVE: To define the
effectiveness of
imaging and treatment measures and to identify risk factors for
recurrence, the series was
reviewed to analyze cause, management, and outcome. SUMMARY OF
DATA: Rotatory subluxation of the atlantoaxial complex remains a poorly
understood entity.
Despite many reports in the literature, there is no consensus about
which imaging studies
should be used for diagnosis and which patients benefit from collar
immobilization, traction, or
surgical fusion. METHODS: Between August 1990 and April 1997, 20
children with
atlantoaxial rotatory subluxation were treated. Fourteen patients (70%)
were girls and six
(30%) were boys (mean age, 6.4 years). All patients had torticollis and
neck pain with
decreased cervical motion for a mean of 11.2 days before diagnosis.
Seven patients (35%) had
a history of pharyngitis or otitis media, four (20%) had recently
undergone head or neck
surgery, and four (20%) had sustained a traumatic injury; in five
patients (25%), no clear cause
was determined. All patients were neurologically intact and underwent
plain cervical
radiographs and dynamic cervical computed tomography to document
atlantoaxial rotatory
subluxation. Patients were then treated with a rigid cervical collar and
agents (n = 5) or with cervical traction followed by immobilization (n =
15). RESULTS: In
four of the five patients in collars, reduction occurred spontaneously,
whereas the fifth required
cervical traction and eventual fusion for recurrence. In the 16 patients
treated with traction
(median, 1.8 kg), the normal atlantoaxial alignment was restored in 15
patients (94%) within a
mean of 4 days. Of the 20 patients treated overall, conservative
management failed in 6 (30%),
and they required posterior fusion because of recurrence of the
atlantoaxial rotatory
subluxation or unsuccessful reduction. The major factor predicting the
failure of conservative
management was the duration of subluxation before initial reduction.
Patients with
long-standing subluxation were more likely to experience recurrence and
require surgery.
There were no complications noted. At follow-up, all patients who were
treated conservatively
remained neurologically intact with a normal atlantoaxial relation. All
patients who underwent
surgery remained neurologically intact and had radiographic
documentation of fusion.
CONCLUSION: Optimal management of atlantoaxial rotatory subluxation
entails early
diagnosis with plain cervical radiographs and dynamic computed
tomography. Closed
reduction with cervical traction followed by rigid immobilization
accomplished reduction in
15 of 16 patients (94%) and was curative in 10 of 16 patients (63%).
Although reduction was
achieved more rapidly and effectively with traction than with a collar,
there may be a role for
simple immobilization without reduction in patients with a short
duration of symptoms. There
does not appear to be a correlation between cause of atlantoaxial
rotatory subluxation, age, or
sex and the likelihood of recurrence.

2) Atlantoaxial rotary subluxation in children.

Muniz AE - Pediatr Emerg Care - 1999 Feb; 15(1): 25-9

NLM Citation ID:

Author Affiliation:
Department of Emergency Medicine, St. Christopher's Hospital for
Children, Philadelphia,
Pennsylvania, USA. [log in to unmask]

Muniz AE; Belfer RA

Traumatic torticollis is an uncommon complaint in the emergency
department (ED). One
important cause in children is atlantoaxial rotary subluxation. Most
children present with pain,
torticollis ("cock-robin" position), and diminished range of motion. The
onset is spontaneous
and usually occurs following minor trauma. A thorough history and
physical examination will
eliminate the various causes of torticollis. Radiographic evaluation
will demonstrate persistent
asymmetry of the odontoid in its relationship to the atlas. Computed
tomography, especially a
dynamic study, may be needed to verify the subluxation. Treatment varies
with severity and
duration of the abnormality. For minor and acute cases, a soft cervical
collar, rest, and
analgesics may be sufficient. For more severe cases, the child may be
placed on head halter
traction, and for long-standing cases, halo traction or even surgical
interventions may be
indicated. We describe two patients with atlantoaxial rotary
subluxation, who presented with
torticollis, to illustrate recognition and management in the ED.

3) The fate of missed atlanto-axial rotatory subluxation in children.

Schwarz N - Arch Orthop Trauma Surg - 1998; 117(4-5): 288-9

NLM Citation ID:

Full Source Title:
Archives of Orthopaedic and Trauma Surgery

Author Affiliation:
Unfallkrankenhaus, Klagenfurt, Austria.

Schwarz N

Torticollis in children can be due to atlanto-axial rotatory
subluxation. If diagnosis, based on
plain lateral radiography and on computed tomography, and specific
treatment are delayed,
reduction becomes difficult to accomplish. Atlanto-axial fusion might be
indicated to cure the
instability. Thus, a diagnostic delay may prevent restoration of
cervical spine function. In
acquired torticollis in children, radiographic evaluation is indicated
if the symptoms are not
relieved within 1 week, but immediate radiography is indicated in
traumatic torticollis.

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