PMC3275470_01
Atlantoaxial computed tomography scan. Atlantoaxial rotation of 46  to the left.
1752-1947-6-27-1.jpg
PMC3275470_01_1752-1947-6-27-1.jpg
F1
A computed tomography (CT) scan revealed an atlantoaxial rotation of 46  to the left without any signs of osseous lesions (Figure 1).
Transbuccal fluoroscopy after reduction. Arrows point to the asymmetric distances between the lateral masses of the atlas and the dens axis.
1752-1947-6-27-2.jpg
PMC3275470_01_1752-1947-6-27-2.jpg
F2
However, a fluoroscopic control still showed signs of atlantoaxial pathology (Figure 2) and magnetic resonance imaging (MRI) of the cervical spine was done (Figure 3).
Atlantoaxial magnetic resonance imaging. Arrows point to the intact alar ligaments.
1752-1947-6-27-3.jpg
PMC3275470_01_1752-1947-6-27-3.jpg
F3
However, a fluoroscopic control still showed signs of atlantoaxial pathology (Figure 2) and magnetic resonance imaging (MRI) of the cervical spine was done (Figure 3).
Sagittal magnetic resonance imaging (T2). The magnetic resonance imaging scan of the cervical spine on the day of trauma (A) shows an epidural mass (arrows) dorsally to C5/C6 - probably a hematoma or a disc protrusion, without signs of myelopathy. Six weeks later (B) the mass has decreased in size, the remaining disc C5/C6 is intact.
1752-1947-6-27-4.jpg
PMC3275470_01_1752-1947-6-27-4.jpg
F4
It showed the integrity of the transverse and the alar ligaments and a traumatic discus protrusion on level C5/6 (Figure 4).
Rotatory computed tomography scan. Atlas (A + B) and axis (C + D) with the head rotated to the left (A + C) and to the right (B + D).
1752-1947-6-27-5.jpg
PMC3275470_01_1752-1947-6-27-5.jpg
F5
After three days of immobilization and analgesic therapy, a CT (with maximum bilateral head rotation) showed no persisting atlantoaxial fixation (Figure 5).