Abstract
Study Design: Case report Objective: This study aimed to highlight that Atlantoaxial rotatory fixation (AARF) can be related to neurosurgery procedures in children with an afterwards demonstration of good results after halo-gravity traction and C1-C2 stabilization using the Harms technique. Summary of Background Data: AARF is characterized by dislocation or subluxation of the atlantoaxial joint, leading to a rotational deformity which may cause pain. Such a condition is mostly found in pediatric patients. Trauma, upper respiratory infections, surgery of the head and the neck, and even rheumatoid arthritis and Down syndrome have been designated as predisposing factors. It is important to note that in some cases AARF evolves with no apparent cause and to date, the choice of optimal surgical procedure should be carefully selected, considering the anatomical and bone conditions, as well as the surgeon’s experience with each technique. Methods: We report the first case related, in our knowledge, of a 4-year-old boy who presented atlantoaxial rotatory fixation after a posterior fossa craniotomy to treat a cerebellar astrocytoma. Results: At our medical facility, we diagnosed AARF by plain radiograph and CT image, and he was treated with continuous cranial traction for 14 days. Initially, we detected that he had no C1 posterior arch or C2 spinous process, so our choice was to perform Harms technique. Postoperatively, the patient was placed in a cervical collar for four weeks. At him 4-years postoperative follow-up, he was doing well and did not develop any complication. Conclusion: We call the attention to the fact of AARF can be developed after neurosurgical procedures. A surgical technique to be used in Atlantoaxial subluxation should be carefully select. In our case, Harms technique after cranial traction was an excellent option to correct and stabilize the abnormal neck position presented. However, further studies are required to determine the best technique to be used in the pediatric population.
Painful torticollis due to tubercular atlantoaxial rotatory fixation: A case report