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.
Dr. Arun Pal Singh
Your article on Rotary Subluxation of C1 C2 Vertebrae is very interesting. I have my C2 rotated and have been in pain for 24 years. No doctor wants to operate and conservative treatment doesn’t help a lot. Could I have a paid telephone consultation with you?
Many thanks
Wendy Swann
Dr Arun Pal Singh Reply:
April 30th, 2012 at 1:51 pm
@Wendy Swann,
Thank you. I do not do paid consultations on phone. You can ask the query by mail and I would be happy to reply that.
Dear Dr Singh
You kindly said you would reply to my query by mail.
I have had C2 subluxation without displacement for 24 years and have a lot of pain. Is it too late to operate (I have tried all the treatments)? Doctors have always told me there is nothing to operate but my neck is blocked with very limited lateral flexion to the left (C2 rotated to the left).
Thank you for taking an interest in my problem.
Best regards
WendyMary
Dr Arun Pal Singh Reply:
May 2nd, 2012 at 5:18 pm
@Wendy Swann,
You must have been evaluated in detail. Can I see your latest record or documents.
You could send them by mailing the images at contact [at] boneandspine [dot] com.
Have you discussed the treatment options with your treating doctors.
Yes! 24 years is kind of late to restore anything. The question is not whether it can be operated or not.
Question is – would surgery, with all its risks and morbidity help you and improve the outcome?