Surgical treatment of children with non-traumatic old atlanto-axial rotatory fixation

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Atlanto-axial rotatory fixation (AORF) develops on the background of acute torticollis. Widely adopted terms such as C1 subluxation or atlantooccipital rotational subluxation do not reflect the core of this pathology and carry negative weight in the diagnostics and treatment of AORF. Retrospective analysis of the diagnostics and treatment outcome of 5 children with confirmed AORF diagnosis and literature review were performed. Clinical method, radiography and functional computer tomography were used to verify the diagnosis. De-rotational halo-traction and open correction with screw fixation were applied for treatment. Head position was managed to be improved in all patients. In one case the reduction was performed using correction in suboccipital segments and in other 4 cases the correction and fixation by Harms and de-rotational halo-traction allowed to correct torticollis. The pain syndrome had been arrested completely. Disease outcome resulted in formation of C1-C2 fibrous or bone fusion regardless the method of treatment. The patients with neglected AORF represent a great challenge for diagnostics and treatment. When conservative treatment fails it is necessary to involve de-rotational halo-traction with possible application of open reduction and posterior fusion. The purpose of treatment is to eliminate torticollis and pain using creation of proper C1-C2 alignment. The motions in atlantooccipital joint do not restore due to formation of the fibrous or bone fusion.

About the authors

A. V. Gubin

Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopedics»

Author for correspondence.
director Russian Federation

A. V. Burtsev

Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopedics»

orthopedic surgeon Russian Federation

S. O. Ryabykh

Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopedics»

head of laboratory of axial skeleton pathology and neurosurgery Russian Federation

D. M. Savin

Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopedics»

orthopedic surgeon, laboratory of axial skeleton pathology and  neurosurgery Russian Federation

P. V. Ochirova

Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopedics»

orthopedic surgeon Russian Federation

A. A. Korkin

Ilizarov Russian Scientific Center «Restorative Traumatology and Orthopedics»

MD. orthopedic surgeon, laboratory of axial skeleton pathology and neurosurgery Russian Federation


  1. Ветрилэ С.Т., Колесов С.В. Краниовертебральная патология. М.: Медицина; 2007. 320 с.
  2. Губин А.В. Алгоритм действий хирурга при острой кривошее у детей. Травматология и ортопедия России. 2009; (1):65-69.
  3. Губин А.В., Бурцев А.В. Задняя фиксация краниоцервикального перехода с использованием винтовых конструкций. Хирургия позвоночника. 2014; (2):42-48.
  4. Губин А.В., Ульрих Э.В., Ялфимов А.Н., Тащилкин А.И. Подвывих C1-C2 – миф или реальность в генезе острой кривошеи у детей? Хирургия позвоночника. 2008; (4):8-12.
  5. Скрябин Е.Г., Смирных А.Г. Переломы тел позвонков в структуре детского травматизма. Травматология и ортопедия России. 2012; (3):106-110.
  6. A lanay A., Hicazi A., Acaroglu E., Yazici M., Aksoy C., Cila A. et al. Reliability and necessity of dynamic computerized tomography in diagnosis of atlantoaxial rotatory subluxation. Spine. 2002; 22(6):763-765.
  7. Burkus J.K., Deponte R.J. Chronic atlantoaxial rotator fixation correction by cervical traction, manipulation, and bracing. J Pediatr Orthop. 1986; 6:631-635.
  8. Crossman J.E., David K., Hayward R., Crockard H.A. Open reduction of pediatric atlantoaxial rotatory fixation: long-term outcome study with functional measurements. J Neurosurg. 2004; 100:235-240.
  9. Crossman J.E., Thompson D., Hayward R.D., Ransford A.O., Crockard H.A. Recurrent atlantoaxial rotatory fixation in children: a rare complication of a rare condition. Report of four cases. J Neurosurg. 2004;100 (3 Suppl Spine):307-311.
  10. F ernández Cornejo V.J., Martínez-Lage J.F., Piqueras C., Gelabert A., Poza M. Inflammatory atlanto-axial subluxation (Grisel’s syndrome) in children: clinical diagnosis and management. Childs Nerv Syst. 2003;19(5-6):342-7.
  11. Govender S., Kumar K.P. Staged reduction and stabilisation in chronic atlanto-axial rotatory fixation. J Bone Joint Surg. 2002; 84-B:727-731.
  12. Gubin A.V., Ulrich E.V., Taschilkin A.I., Yalfimov A.N. Etiology of child acute stiff neck. Spine. 2009; 34(18):1906-1909.
  13. H ettiaratchy S., Ning C., Sabin I. Nontraumatic atlantooccipital and atlan-toaxial rotator subluxation: case report. Neurosurg. 1998; 43:162-164.
  14. Li V., Pang D. Atlantoaxial rotatory fixation. In: Disorders of the pediatric spine. New York; 1995. p. 531-553.
  15. Maigne J.Y., Mutschler C., Doursounian L. Acute torticollis in an adolescent: case report and MRI study. Spine. 2003; 28(1):13-15.
  16. Park S.W., Cho K.H., Shin Y.S., Kim S.H., Ahn Y.H., Cho K.G. et al. Successful reduction for a pediatric chronic atlantoaxial rotatory fixation (Grisel syndrome) with long-term halter traction: case report. Spine (Phila Pa 1976). 2005; 30(15):E444-449.
  17. Subach B.R., McLaughlin M.R., Albright A.L., Pollack I.F. Current management of pediatric atlantoaxial rotator subluxation. Spine. 1998; 23(20):2174-2179.
  18. W ang J., Vokshoor A., Kim S., Elton S., Kosnik E., Bartkowski H. Pediatric atlantoaxial instability: management with screw fixation. Pediatr Neurosurg. 1999; 30(2):70-78.

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