PMC4111947_01
Photograph of the patient taken at admission, demonstrating anomalous rotation of the head to the right.
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There was spasm of the ipsilateral sternocleidomastoid muscle associated with nuchal pain that was exacerbated by the attempt to perform contralateral active rotation (Fig. 1).
Computed tomography of the cervical spine. The coronal image demonstrates asymmetry of the lateral masses of the atlas, with apparent "increase of the left lateral mass" dislocated anteriorly (A). The sagittal image demonstrates normal distance of the atlantodental interval (B).
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Computed tomography (CT) of the cervical spine demonstrated atlantoaxial rotatory subluxation to the right, with anterior dislocation of the left articular facet of the atlas and a normal atlantodental interval (ADI) of 2 mm (Fig. 2).
Three-dimensional reconstruction reveals rotatory subluxation between C1 and C2. Note the articular facet of C1 anteriorly dislocated to the left and blocked.
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Clinical reduction of the subluxation occurred after 48 hours, with centralization of the head (Fig. 3).
Photograph of the patient on day 3 of conservative treatment demonstrating the head in a neutral position, indicating clinical reduction of atlantoaxial rotatory subluxation. The restoration of neutral position left the cervical collar loose.
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Magnetic resonance of the cervical spine was performed 20 days after reduction and demonstrated that the odontoid process was slightly shifted to the right (Fig. 4), with the presence of fluid on the C1-C2 articular facets.
Magnetic resonance of the cervical spine, T2 sequence, after spontaneous reduction of the lesion. Observe the joint effusion on the anterior and posterior facets of the dens on the axial image. Intact transverse ligament of the axis (A). Joint effusion anterior to the dens on the sagittal image (B). Note the joint effusion in the atlantoaxial joint in the coronal image (C). Anteroposterior radiograph taken after 6 months demonstrates a reduced atlantoaxial joint (D).
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Six weeks after reduction, the patient was completely asymptomatic and the radiograph demonstrated an anatomical C1-C2 relation (Fig. 5).