Non-Operative Treatment in Children and Adolescents with Atlantoaxial Rotatory Subluxation

Objective: Atlantoaxial rotatory subluxation (AARS) is an uncommon lesion seen mainly in children and adolescents. A retrospective analysis of 12 patients with AARS treated non-operatively is presented in this study. Material and Methods: Twelve patients with AARS who were treated non-operatively were evaluated retrospectively in terms of recent trauma and respiratory tract infection history, accompanying injuries, radiological findings, duration of symptoms, amount and duration of traction and clinical results of the treatment. Results: Traumatic AARS was present in 8 patients. No evidence of trauma was found in 4 patients. Type I subluxations in 10 and type II subluxations in 2 patients were found according to the Fielding and Hawkins classification. All patients were treated using bed-side mentooccipital tractions. The mean duration of bed-side mentooccipital traction was 3,75 days and the mean amount of load was 1.8 kg. All patients were kept in Philadelphia collars for additional 3 weeks after the clinical recovery. No limitations and pain in head movements were present in any patient at the sixth month follow-up examinations. Conclusion: Paediatric patients with neck pain and torticollis should be investigated concerning trauma and recent respiratory tract infection history in order to avoid any delay in diagnosis of a possible AARS. Turkish Anahtar Kelimeler: Atlanto-Axial Eklem, Tortikolis, Boyun Agrisi Amac: Atlantoaksiyel rotator subluksasyon (AARS) cocuk ve adolesanlarda bas-boyun hareketlerinde kisitlilik ve tortikollisle kendini gosteren, genellikle tanida gucluk yasanan ve beraberinde potansiyel riskler barindiran bir durumdur. Bu calismada cerrahi disi yontemlerle tedavi edilen 12 AARS olgusunun retrospektif analizi sunulmaktadir. Hastalar ve yontem: AARS nedeni ile cerrahi disi yontemlerle tedavi edilen, ortalama yasi 11,5 olan 12 hasta travma ve ust solunum yolu enfeksiyonu oykusu, ek yaralanmalar, radyolojik bulgular, semptomlarin suresi, mentooksipital traksiyonun miktari ve suresi ile tedavinin klinik sonuclari acisindan degerlendirildi. Bulgular: Olgularin 8'inde travmatik AARS saptanirken, 4 olguda subluksasyonlarin ardinda travmatik bir neden bulunamadi. Olgularin 10'unda Fielding ve Hawkins'e gore tip I, 2'sinde ise tip II subluksasyonlar saptandi. Tum olgular yatak basi mentooksipital traksiyonla tedavi edildi. Traksiyonda kullanilan ortalama agirlik 1,8 kg iken, ortalama traksiyon suresi 3,75 kg olarak hesaplandi. Olgular traksiyonla elde edilen klinik duzelmenin ardindan 3 hafta Philadelphia boyunlukla takip edildi. Altinci ay kontrollerde hicbir olguda bas-boyun hareketlerinde kisitlilik ve agri saptanmadi. Sonuclar: Atlantoaksiyel eklem, bas rotasyonunun cogundan sorumlu olan karmasik bir yapidir. Cocuk ve adolesanlarda boyun agrisi ve torticollis ayirici tanisinda atlantoaksiyel eklem patolojileri ve AARS mutlaka dusunulmeli ve ekarte edilmelidir. Tanida gecikme yasanan olgularin tedavisinde cerrahi disi yontemlerle basari sansi dusuktur.