• Unilateral facet subluxation with intact transverse ligament • Odontoid acts as a pivot point with 1 facet subluxating anteriorly, 1 facet subluxating posterioly. • Most common and benign type
• Unilateral facet subluxation with 3 to 5 mm of anterior displacement. • Injured Transverse ligament • 1 facet acts as pivot point and 1 lateral mass is displaced anteriorly
• Bilateral anterior facet displacement of > 5 mm. • Rare with higher risk of neurologic involvement or instantaneous death. • Both lateral masses are displaced
• Posterior displacement of atlas (C1) (with odontoid fracture, or hypoplastic dens) • Rare with higher risk of neurologic involvement or instantaneous death
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A 3-year-old girl developed torticollis eight months ago after a severe respiratory tract infection. A initial trial of halter traction was attempted without success. A trial of halo traction was then performed for 3 weeks and then a dynamic computed tomographic (CT) was obtained and shown in Figure A. Panel (a) shows an axial image with maximal rotation to the left. Panel (b) shows an axial image with maximal rotation to the right. What is the most appropriate next step in management?
No further treatment
Closed reduction under conscious sedation
Closed reduction under general anesthesia in the operating room with neurologic monitoring
Posterior atlantoaxial fusion
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A 5-year-old boy develops spontaneous atlantoaxial rotatory subluxation shortly after an upper respiratory infection. No neurologic symptoms are present. He is initially treated with soft collar immobilization and rest. After a week, he continues to hold his head tilted and rotated with no change in his neurologic status. A current cervical radiograph is shown in Figure A. What is the next most appropriate treatment option for this patient?
Continued soft collar immobilization and rest
Halter traction, muscle relaxants and analgesics
Halo skeletal traction
Cervical stretching and immobilization in a stiff collar