Preliminary CT study of C1-C2 rotational mobility in normal subjects

A CT study of normal atlanto-axial (C1-C2) rotary mobility was carried out on ten normal immature subjects. In order to determine the limits of normality, the ten children underwent clinical and radiological examination. The clinical study included checking for objective signs of joint laxity and measurement of rotational neck mobility. The radiological study included standard lateral radiographs in neutral and maximal flexion positions and a CT scan taken in maximal left and right side rotation at the C1-C2 articular processes joint. The superpositioning of the images taken in every rotational direction showed, in all ten children, a wide contact loss between the C1-C2 corresponding facets, ranging from 74 to 85% of the total articular surface. The report on these images, carried out by three independent radiologists, concluded that there was a rotary subluxation in all cases. In the ten children studied, there were no significant differences with regard to neck mobility or laxity signs in clinical or standard X-ray examination. Our results lead us to conclude that, except for complete C1-C2 rotational dislocation with facet interlocking, a CT scan showing a wide - but incomplete - rotational facet displacement is not sufficient to define a status of subluxation. This leads us to perceive that there is a risk of overdiagnosis when evaluating upper cervical spine rotational problems in children. The concept of both rotary C1-C2 fixation and subluxation should be revised.