In 17 cases of irreducible atlanto-axial rotatory subluxation (here called fixation), the striking features were the delay in diagnosis and the persistent clinical and roentgenographic deformities. All patients had torticollis and restricted, often painful neck motion, and 7 young patients with long-standing deformity had flattening on one side of the face. The diagnosis was suggested by the plain roentgenograms and tomograms and confirmed by persistence of the deformity as demonstrated by cineroentgenography. Treatment included skull traction, followed by atlanto-axial arthrodesis if necessary. Of the 13 patients treated by atlanto-axial arthrodesis, 11 had good results, one had a fair result, and one had not been followed for long enough to determine the result. Of the remaining 4 patients, one treated conservatively had not been followed for long enough to evaluate the result, 2 declined surgery, and one died while in traction as the result of cord transection produced by further rotation of the atlas on the axis despite the traction.
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In 17 cases of irreducible atlanto-axial rotatory subluxation (here called fixation), the striking features were the delay in diagnosis and the persistent clinical and roentgenographic deformities. All patients had torticollis and restricted, often painful neck motion, and 7 young patients with long-standing deformity had flattening on one side of the face. The diagnosis was suggested by the plain roentgenograms and tomograms and confirmed by persistence of the deformity as demonstrated by cineroentgenography. Treatment included skull traction, followed by atlanto-axial arthrodesis if necessary. Of the 13 patients treated by atlanto-axial arthrodesis, 11 had good results, one had a fair result, and one had not been followed for long enough to determine the result. Of the remaining 4 patients, one treated conservatively had not been followed for long enough to evaluate the result, 2 declined surgery, and one died while in traction as the result of cord transection produced by further rotation of the atlas on the axis despite the traction.
Copyright remains with the authors and publisher.