Atlanto-axial rotatory subluxation in children: early management

Atlanto-axial rotatory subluxation (AARS) is an uncommon condition involving dislocation and abnormal fixation of the atlas on the axis. AARS is difficult to diagnose and if improperly treated it may lead to permanent neck deformity. We report a retrospective series of patients diagnosed with AARS seen during the last five years. The children presented with neck pain, head tilt, and reduction in neck mobility. In three of the cases the condition was secondary to cervical trauma and in the fourth it was associated with otitis (Grisel syndrome). The diagnosis was established by three-dimensional computerised tomography. In three cases, the atlanto-axial fixation was cured after cervical immobilisation and physiotherapy. A posterior cervical fusion was required in the remaining case. Early detection and intensive conservative treatment constitutes the mainstay of management of AARS. Surgery is reserved for cases with irreducible or recurrent subluxation.