A Pediatric Radiology Textbook and Pediatric Radiology Digital Library
Pediatric Atlanto Axial Rotatory Subluxation
Etiology: — Traumatic — Inflammatory from head and neck or upper respiratory infection — Juvenile idiopathic arthritis
Imaging CT: — C1 is rotated to left or right on C2 — CT can be done in neutral position and with maximum rotation to left and right to help diagnose fixed rotatory subluxation
DDX:
Complications:
Treatment:
Clinical:
Radiology Cases of Atlanto Axial Rotatory Subluxation
Axial CT without contrast of the cervical spine shows the C1 vertebral body rotated to the left approximately 45 degrees in relation to the C2 vertebral body.3D CT without contrast of the cervical spine shows the C1 vertebral body rotated to the left approximately 30 degrees in relation to the C2 vertebral body.Axial images with bone windows from a CT with contrast of the neck shows the C1 vertebral body (above left) rotated approximately 30 degrees to the right in relation to the C2 vertebral body (above right). Axial image with soft tissue windows (below) from the same CT shows a low density fluid collection with an enhancing rim to the left of midline in the retropharyngeal space.Axial images from a CT without contrast of the cervical spine shows the C1 vertebral body rotated to the left approximately 45 degrees (top) in relation to the C2 vertebral body (middle). A MIP image (bottom) better demonstrates the rotation of C1 on C2.Axial CT without contrast of the cervical spine obtained after the accident shows C1 vertebral body rotated 45 degrees to the right (upper left) on the C2 vertebral body (lower left). Axial CT without contrast of the cervical spine obtained 1 day later shows C1 vertebral body now normally aligned (upper right) with the C2 vertebral body (lower right)
