Staged Management of Chronic Atlantoaxial Rotatory Subluxation With Halo-Gravity Traction and Cervical Fusion

Case: A 10-year-old girl presented with a 16-month history of persistent head tilt, restricted neck motion, and neck pain. Imaging demonstrated chronic atlantoaxial rotatory subluxation (AARS) with underlying congenital C1 arch diastasis. Preoperative halo-gravity traction (HGT) was performed over 2.5 weeks, achieving partial realignment, followed by C1 to C2 posterior spinal fusion with iliac crest autograft. Postoperatively, the patient demonstrated stable alignment and resolution of neck pain. Conclusion: Chronic AARS may be successfully treated using a staged approach with preoperative HGT followed by cervical arthrodesis.