The Axis Vertebra by Demetrios S. Korres

Author:Demetrios S. Korres
Language: eng
Format: epub
Publisher: Springer Milan, Milano

Fig. 10.4CT scans show a type I traumatic rotatory atlantoaxial dislocation

Fig. 10.5Three dimensional reconstruction CT scans show a type I traumatic AARD

10.1.5 Treatment

Treatment must start immediately after the injury to avoid shrinking of the soft tissue of the joints and stiffness of the deformed cervical spine. The time elapsed between diagnosis and treatment determines the results and prognosis. Treatment time has been shown to correlate with the recurrence of dislocation recurrence and failure of reduction. After the diagnosis of atlantoaxial dislocation with a CT-scan, reduction must be attempted with manipulation and application of jaw-occipital or skeletal traction.

Reduction of the dislocation has to be accomplished within the first 2–3 days following the injury [6, 7, 17]. Following adequate reduction, patient’s cervical spine is immobilized with a cervical collar or a halo vest for 6–10 weeks. The patient should be followed up regularly with radiographs until stability of the cervical spine is achieved. Treatment with closed reduction and immobilization resolves the torticollis and restores the distortion in almost 95% of cases. Patients receiving delayed treatment require cervical skeletal traction for 5–8 days and immobilization for a longer period, until 3 months with a halo vest. If the time elapsed between diagnosis and treatment is more than 3 weeks, a high rate of reduction failure and if reduced (difficult) recurrence is observed [6–8, 11–13, 18].

When the treatment is delayed or the dislocation is not reduced, permanent deformity is installed making impossible the reduction of the lesion. In such cases, reduction with a hallo vest or surgical treatment and arthrodesis of the atlantoaxial complex to avoid further instability represents the only feasible treatment options (Fig. 10.6).

Fig. 10.6Schematic presentation and radiograph show an unstable type IV traumatic rotatory atlantoaxial dislocation

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