The C1-C2 rotatory instability caused by subluxation or facet dislocation common cause of torticollis.The pathophysiology common causes include Grisel syndrome or infection (35%), trauma (24%) and other associated conditions with Down Syndrome, Rheumatoid Arthritis, Ankylosing Spondylitis, Klippel Feil Syndrome and odontoid congenital anomalies. The spasticity was improved when compare with preoperative examination and follow-up radiograph images confirmed the atlas and axis have been repositioned. The patient improved relief of his torticollis, neck pain and gaiting balance was improved with able ambulate without assistance. The patient received rehabilitation program. Post-operatively radiographs were satisfactory ( Fig. The occipital plate screws were performed from occiput to C2. We removed the left C1 lateral mass screw and applied the occipitocervical fixation. 2B) however rod contour unable to place at left C1 and C2 due to the rotary of C1. C1 lateral mass screws and C2 pars screw were placed bilaterally under navigation assistance ( Fig. The axial traction was applied in an attempt to partially reduce the C1-C2 rotatory dislocation and corrected the torticollis. Intraoperatively finding found that the C1 was rotated over C2 with bilateral facet joint dislocation ( Fig. Under general anaesthesia in the prone position with skull immobilization (Mayfield head holder), the patient underwent the standard posterior midline approach from C1 to C2. The team discussed with his parents treatment plan and complication. These findings established the diagnosis of rotatory atlanto-axial dislocation corresponding to type III in the classification scheme developed by Fielding and Hawkins. The floor of the skull was pressed by the dens and the tip of the odontoid that reported basilar invagination ( Fig. The atlanto-dental space was widening and stretching of transverse ligaments of the atlas ( Fig. 2B) of the cervical spine were atlanto-axial dislocation without bony fracture. 2A) and magnetic resonance imaging (MRI) ( Fig. Patient's assessment, the mechanism of injury was hyperextension, possibly combined with rotatory forces, may lead to horizontal displacement of the lateral facet joints of C1/C2. 1A) and the lateral view showing anterior dislocation of C1 ( Fig. The radiographic x-ray of cervical spine anteroposterior (AP) view was unseen the C1 over C2 ( Fig. Per rectal examination: normal sphincter tone. Reflexes increased deep tendon reflexes (3+), Gaiting and balance was a spastic gait and was unable to ambulate without assistance. Physical examination showed initial vital sign was normal, mental status was fully alert and speech was clear, cranial nerves (CN II - CN XII) were not found abnormally, Motor power and sensory of upper-lower extremity was grade V all.
However, he was untreated due to the COVID-19 pandemic situation. He had a progressive neck pain and a limitation on his neck rotation. His parents gave a patient history which included that the patient also had a trauma from a fall 9 months ago. An 8-year-old male presented to the orthopaedic outpatient clinic with complaints of torticollis and neck pain.
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