Journal List > J Korean Soc Spine Surg > v.18(4) > 1075944

Kim, Ahn, Yang, Yi, and Kim: The Treatment of Traumatic Atlantoaxial Rotatory Subluxation (Fielding Type I) and the Correlation between the Clinical Progress and Radiological Reduction Parameter

Abstract

Study Design

This is a retrospective study.

Objectives

We will discuss clinical outcomes of adult traumatic atlantoaxial rotatory subluxation (Fielding type I) and verify the correlation between the clinical outcomes and radiological reduction rate.

Summary of Literature Review

Atlantoaxial rotatory subluxation which usually occur in children by non-traumatic sources or minor trauma has been discussed persistently. However, studies of atlantoaxial rotatory subluxation which occur in adults over 20 years old, especially by traumatic injury is rare.

Materials and Methods

From October 2004 to April 2011, thirty patients diagnosed of traumatic atlantoaxial rotatory subluxation with 6 months followup period were enrolled in the study. After diagnosis, we started treating Halter traction with 5 lbs. We discontinued traction when the patient recovered over 90% of ROM and applied Philadelphia collar to the patient. We measured visual analogue scale (VAS) for cervical pain and ROM. We measured atlanto-dens interval (ADI) and lateral mass-dens interval (LDI) difference using three-dimensional computed tomography (3D-CT) to validate radiological reduction rate.

Results

At the end of followup, none of the patients complained over pain and all recovered to full ROM. ADI was in normal range during the whole treatment period. LDI difference gradually decreased during treatment period, however, only 8 cases (26.7%) came back to normal range.

Conclusions

In traumatic atlantoaxial rotatory subluxation (Fielding type I), satisfactory clinical outcomes such as pain relief or ROM improvement using traction and the radiological reduction rate was also improved but it failed to achieve a complete reduction of LDI difference in radiography.

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Figures and Tables%

Fig. 1.
The following 3D-CT coronal images are in the order as following; (A) initial, (B) pain relief, (C) full ROM recovery and (D) 2 weeks, (E) 4 weeks, (F) 8 weeks after applying a brace. Lateral mass-Dens Interval (LDI) difference is calculated by subtracting b from a.
jkss-18-202f1.tif
Fig. 2.
The following graph shows Lateral mass-Dens Interval(LDI) difference at diagnosing point, 2 weeks, 4 weeks, 8 weeks after applying a brace.
jkss-18-202f2.tif
Table 1.
VAS, ROM and LDI difference
The point of VAS* ROM LDI difference
Flexion Extension Rotation to subluxated direction /Rotation to opposite direction
Diagnosis 8.0±0.7 21.5±7.6 19.3±10.1 47.0±10.2/33.0±9.2 1.9±1.0
Pain relief 1.3±0.5 34.2±6.2 29.8±8.4 64.3±7.2/57.0±7.9 1.6±0.7
ROM recovery 0.3±0.5 45 45 80/80 1.5±0.8
brace for 2 weeks 0 45 45 80/80 1.4±0.7
brace for 4 weeks 0 45 45 80/80 1.0±0.5
brace for 8 weeks 0 45 45 80/80 0.9±0.5

VAS; visual analogue scale,

ROM; range of motion,

LDI; Lateral mass-dens interval

Table 2.
Data analysis using Wilcoxon test
The point of diagnosing a disease ~ ROM recovery
Z -3.261(a)
Two-tailed p-value 0.01>
Table 3.
Data analysis using Friedman test
The point of Average of the ranks
Diagnosis 3.73
Applying brace for 2 weeks 3.02
Applying brace for 4 weeks 2.07
Applying brace for 8 weeks 1.18
N 30
Chi-square 66.993
Degree of freedom 3
p-value 0.01>
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