Post-traumatic Atlantoaxial Rotatory Fixation in an Adult

In Brief Study Design. A case report. Objective. To describe an interesting patient who underwent open reduction and C1–C2 transpedicular screw fixation with interspinous wiring due to high-riding vertebral artery. Summary of Background Data. Atlantoaxial rotatory fixation (AARF) is a rare complication found most frequently after trauma in children and young adults; the clinical diagnosis is difficult and often made late. Methods. We report a case of post-traumatic AARF associated with a facet fracture in an adult. Reduction proved difficult to obtain by skull traction and gentle manipulation. Therefore, after open reduction under general anesthesia, we performed C1–C2 transpedicular screw fixation with posterior wiring to avoid vertebral artery injury due to high-riding transverse foramen at the C2 vertebra. Results. The normal atlantoaxial relation was restored and the torticollis resolved. The patient remains neurologically intact and has radiographic documentation of fusion. Conclusion. Although technically demanding, C1–C2 transpedicular screw fixation combined with interspinous bone graft wiring after open reduction may be an alternative treatment option if conservative treatment fails to reduce AARF. We report a rare case of post-traumatic atlantoaxial rotatory fixation in an adult. After failure of closed reduction, we performed open reduction and C1–C2 transpedicular screw fixation, instead of C1–C2 transarticular screw fixation due to high-riding vertebral arteries. Although technically demanding, this procedure may be an alternative treatment option for reduced atlantoaxial rotatory fixation with high-riding vertebral arteries.