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Atlantoaxial Rotatory Fixation: Current Challenges and Advances in Diagnosis and Management
Zirui Ren1, Qifeng Lan1,2, Yinglun Tian1,3,4
1Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
JB & JS Open Access
|July 17, 2026
Summary
Atlantoaxial rotatory fixation (AARF) is a rare pediatric cervical disorder causing torticollis. Diagnosis relies on CT scans, with treatment varying from nonoperative methods to surgical fusion for persistent cases.
Area of Science:
- Orthopedics
- Pediatric Spine Surgery
- Radiology
Background:
- Atlantoaxial rotatory fixation (AARF), or subluxation (AARS), is an uncommon pediatric cervical spine disorder.
- Typically presents as painful torticollis in a "cock-robin" position, often following infections or minor trauma.
Purpose of the Study:
- To review the diagnostic modalities and management strategies for AARF.
- To highlight the importance of classification systems in guiding treatment decisions.
Main Methods:
- Computed tomography (CT) is the gold standard for diagnosing AARF, assessing atlantoaxial alignment and rotational deformity.
- Review of existing classification systems (Fielding and Hawkins, Pang-Li, PUTH) that incorporate reducibility.
- Analysis of treatment options, including nonoperative (immobilization, traction, manipulation under anesthesia) and surgical (C1-C2 fusion).
Main Results:
- CT provides accurate assessment of AARF, crucial for diagnosis.
- Classification systems aid in determining appropriate management based on reducibility and duration.
- Nonoperative treatments are primary, with surgery reserved for irreducible or refractory cases.
Conclusions:
- Standardized diagnostic and treatment algorithms are needed for AARF.
- Management should be tailored based on AARF classification and reducibility.
- Surgical stabilization, such as C1-C2 fusion, is typically a last resort.
