This is an uncommon injury in adults. Rotary C1-C2 subluxation is more common in children and that behaves differently from the injury in adults.
Cause
In adults, the injury is caused by motor vehicle accidents and often may be missed in initial evaluation of the patient.
Presentation
Following an injury , the patient complains of torticollis and restricted neck motion.
Xray
An open mouth view may reveal wink sign. The wink sign is caused due to over riding of C1-2 joint on one side ans normal configuration on other side.
TThis overriding causes he asymmetry of the lateral masses of C1 with respect to the dens and unilateral magnification of a lateral mass of C1 .
However, since the atlantoaxial joint permits flexion, extension, rotation, and lateral bending, radiographic asymmetry is produced when the head is tilted laterally or rotated or if a slightly oblique odontoid view is obtained.
CT scan is helpful in defining the injury clearly.
Treatment
Closed reduction
Acute rotary subluxation can be reduiced by closed methods. After applying a Halo ring, a gentel traction is used to derotate the skull and C1 vertebra. Spinal cord monitoring is done throughout the procedure.
if stable reduction is obtained, it is confirmed radiologically and Halo vest is applied.
Open reduction
Done in cases of late detections or failed closed reduction. Using a posterior incision on neck, the subluxation is reduced manually.
This is followed by C1-C2 fusion.
Immobilization in halo vest is recommended for 8-12 weeks in either type of treatment.
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