Delayed spontaneous reduction of traumatic pediatric atlantoaxial rotatory subluxation

Pediatric atlantoaxial rotatory subluxation (AARS) is a rare finding with various etiologies and treatment recommendations. Etiologies include both traumatic and nontraumatic causes. The diagnosis is suggested by clinical presentation and confirmed with imaging. Various forms of management have been discussed in the literature. However, no overall consensus has been established. We present 2 pediatric cases showing delayed spontaneous reduction of traumatic AARS. Images from computed tomography (CT) were used for initial diagnosis and to track management progression. Although the subluxation persisted on the 1-month follow-up CT in Case 1, the final CT images in both cases showed spontaneous reduction with anatomic positioning of C1 and C2. These cases demonstrate that delayed spontaneous reduction of traumatic pediatric AARS is possible with conservative treatment. Active reduction via traction may not be necessary. In the absence of compelling surgical indications to the contrary, a conservative approach to management of traumatic pediatric AARS is warranted.