• 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 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
Select Answer to see Preferred Response
HPI - Insidious onset of neck pain and painful movement since 2 weeks.
What would be your next step in treatment for this patient?
HPI - The patient is a 23 yo male, college graduate and athlete, with no unusual recent history, that developed severe neck pain 3 days ago. He resports there has been no improvement, and he has difficulty moving his neck.
What do you think is the most likely diagnosis?