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Traumatic atlantoaxial rotatory fixation in adults: a systematic review of published cases

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Abstract

Atlantoaxial rotatory fixation (AARF) in adults is a rare and clinically challenging condition characterized by a spectrum of etiological factors, predominantly attributed to traumatic and inflammatory pathologies within the craniovertebral region. Trauma is the most frequently identified cause within the adult population, with the first case report published in 1907. This study aims to conduct a systematic review that addresses the clinical presentations and management strategies relating to traumatic atlantoaxial rotatory fixation in adults. A comprehensive search of the PubMed database was executed, adhering to the PRISMA guidelines. The inclusion criteria encompassed case reports and series documenting AARF cases in individuals aged 18 and above, spanning database inception to July 2022. Studies not published in the English language were excluded. A total of 61 articles reporting cases of AARF in the adult population were included in the study. The mean age of affected individuals was 36.1 years (± 15.6), with a distribution of 46% females and 54% males. Predominant mechanisms of injury included motor vehicle accidents and falls, constituting 38% and 22% of cases, respectively. Among the classification systems employed, Fielding and Hawkins type I accounted for the majority at 63%, followed by type II at 10%, and type III at 4%. Conservative management was used for treatment in 65% of acute (65%) cases and 29% of chronic cases. Traumatic AARF is a rare phenomenon in the adult population, is more common in younger adults, and does not often present with neurologic deficits. Patients diagnosed acutely are more likely to be successfully treated with conservative management, while patients diagnosed chronically are less likely to be reduced with conservatively and often require surgical treatment. Surgery should be considered for patients with irreducible dislocations, ligamentous injuries, unstable associated fractures, and persistent pain resistant to conservative management.

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Authors and Affiliations

  1. Department of Surgery, Rafsanjan University of Medical Sciences, Rafsanjan, Kerman, Iran

    Saber Zafarshamspour

  2. Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Fars, Iran

    Saber Zafarshamspour & Keyvan Eghbal

  3. Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA

    Emal Lesha

  4. Department of Interventional Radiology, Baylor College of Medicine, Houston, TX, USA

    Mohammad Ghasemi-rad

  5. School of Medicine, Loyola University Chicago, Chicago, IL, USA

    Arba Cecia

  6. School of Medicine, St. George’s University, West Indies, Grenada

    Haydy George

  7. Texas Tech University Health Sciences Center School of Medicine, Houston, TX, USA

    Kelly Trinh

  8. Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Shirin Yaghoobpoor

  9. Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Hamed Ghorani

  10. Indiana University, Indianapolis, USA

    Mohammad E. Majd

Authors
  1. Saber Zafarshamspour
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  2. Emal Lesha
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  3. Arba Cecia
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  4. Haydy George
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  7. Shirin Yaghoobpoor
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  10. Keyvan Eghbal
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Contributions

S.Z., K.E. designed the study; S.Z., S.Y., H.G., L.E., and K.T. collected and analyzed the data; M.G., M.E., and K.E. supervised the study; S.Z, S.Y., H.G., A.C., H.D., and K.M. wrote the manuscript.

Corresponding authors

Correspondence to Saber Zafarshamspour or Keyvan Eghbal.

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Ethical approval was waived by the ethics committee due to the retrospective study design.

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The authors declare no competing interests.

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Zafarshamspour, S., Lesha, E., Cecia, A. et al. Traumatic atlantoaxial rotatory fixation in adults: a systematic review of published cases. Neurosurg Rev 47, 90 (2024). https://doi.org/10.1007/s10143-024-02315-1

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  • DOI: https://doi.org/10.1007/s10143-024-02315-1

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