Traumatic atlantoaxial rotatory dislocation in adults

Pure traumatic atlantoaxial rotatory dislocation (TAARD) is a possible cause of torticollis in children, but very rare in adults. Aim of this study is to report three very rare cases of TAARD in adults, focusing anatomy, management, and outcome. All 3 patients had a head-on automobile accident. Cases included a 26-year old woman, a 21-year old woman, and a 29-year-old man. The first case had a 45-day delay in diagnosis; the second and third cases were suspected to have odontoid lateral mass asymmetry on transoral radiographs. In all cases CT scan confirmed diagnosis and clarified the type of subluxation. All had conservative treatment with reduction and immobilization with Halo-Vest for case 1 and 2, and a rigid cervical collar for case 3. After follow-up of 10 years for case 1 and 2, and 3 years for case 3, all had no sign of C1-C2 complex mobility/instability. Patients 2 and 3 had complete and pain free cervical spine range of motion, while case 1 had stiffness and straightness of the cervical spine, headache, and nerve roots deficits, probably due to the complex cervical spine injury with sagittal imbalance on X-ray and C5-C6 spinal cord compression (pre-existing the trauma). TAARD should be considered in the differential diagnosis of post-traumatic neck pain and limitation, with or without evident torticollis, even in adults. CT scan is mandatory for a correct evaluation of C1-C2 complex. Conservative treatment with reduction followed by 50-60 days of rigid cervical immobilization (3 months in delayed diagnosis) is usually effective. Delay in diagnosis could be the cause of a poor outcome.