Current clinical characteristics and management of pediatric atlantoaxial rotatory subluxation: An ACS TQIP analysis

Introduction

Atlantoaxial Rotatory Subluxation (AARS) is an important differential diagnosis in pediatric patients presenting with torticollis, which is caused by the subluxation of the C1 vertebra relative to the C2 vertebra. Due to the uncommon nature of this condition, there is a paucity in sufficiently sized studies describing this condition. The aim of the current investigation was therefore to characterize current clinical characteristics and management of AARS.

Material & Methods

The American College of Surgeons Trauma Quality Improvement Program database from 2016-2021 was queried for pediatric (≤17 years old) patients who were diagnosed with AARS following blunt trauma. Patients were grouped by age in order to describe and compare demographics, clinical characteristics, and in-hospital outcomes. A subgroup analysis was also performed on patients with isolated AARS, defined as AARS without the presence of a cervical fracture as well as an AIS ≤ 1 in all regions besides the spine.

Results

469 cases of AARS were identified. Of these cases, 211 (45.0%) were isolated AARS. 56.3% of AARS patients and 64.5% of isolated AARS patients were 8 years old or younger. AARS in adolescents was due to a motor vehicle collision in 60.0% of cases, while 52.5% of infants/toddlers were injured in falls. 87.4% of patients with AARS were managed conservatively, with or without a brace/other immobilizing device, while surgery was only indicated in 9.3% of patients. In cases of isolated AARS, conservative treatment was even more prevalent, with 92.4% of patients managed conservatively and only 4.7% requiring surgical intervention.

Conclusions

Atlantoaxial Rotatory Subluxation is most common in children aged 8 and younger, with the majority of cases resulting from falls or motor vehicle accidents. Most cases can be managed conservatively without the need for surgical intervention.

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