Clinical remarks on acute post-traumatic atlanto-axial rotatory subluxation in pediatric-aged patients

Objective. This study aimed to identify specific findings related to acute posttraumatic atlanto-axial rotatorysubluxation in pediatric patients.Methods. We studied 14 children with acute atlanto-axial rotatory subluxations admitted to a hospital over a5-year period after craniocervical injury. Clinical and radiological findings were reviewed to identify newfindings related to atlanto-axial rotatory subluxation.Results. Most patients exhibited a typical picture of atlanto-axial rotatory subluxation, but one child alsoexperienced transient blindness that was related to peculiar anatomical findings on neuroradiological images.A characteristic C2-C3 anterior pseudo-subluxation was detected among the radiographic signs. Magneticresonance imaging showed no clear break in the alar ligaments, which were oriented horizontally. However,unlike the case in adult anatomy, in these children, the alar ligaments were laterally attached at the occipitalcondyle-axis condylar joints. In all children, atlanto-axial rotatory subluxation spontaneously reduced withina few hours after short bed rest without halter traction but with a cervical collar. No recurrence was observedduring follow-up.Conclusions. Acute posttraumatic atlanto-axial rotatory subluxation in pediatric-aged patients is a rapidlyresolving disease of the cranio-cervical junction. The disease appears to be related to an elasticity of thecontralateral alar ligament, which is attached to the occipital condyle-axis condylar joint. Neurologicalsymptoms (blindness) occurred in one patient when the vertebrobasilar blood flow was impaired and nocompensation was provided from the anterior circulation. Use of a cervical collar and short bed rest withouthalter traction is recommended, based on our observations of complete recovery and no recurrence followingthe use of this treatment strategy.