Open reduction of pediatric atlantoaxial rotatory fixation: long-term outcome study with functional measurements

Object. Atlantoaxial rotatory fixation (AARF) is an uncommon disorder of childhood in which resolution usually occurs spontaneously or after traction therapy. In a minority of children irreducible or chronic fixation develop, and the natural history then usually involves restriction of head on neck movement, abnormal head position, and progressive facial asymmetry. The conventional management in these cases has been a posterior fusion. Methods. The authors performed an open reduction via the extreme-lateral approach without adjunctive fixation surgery in 13 children who ranged in age from 4 to 11 years. Postoperatively, halo jacket therapy was undertaken for 8 to 12 weeks. There were no neurological complications despite damage to one vertebral artery and one wound infection. Functional outcome was assessed after a minimum of 24 months (range 29-72 months). Facial asymmetry markedly improved. Sagittal movements were similar to those observed in control individuals. Axial rotation, although reduced compared with that in controls, was present but usually asymmetrical. Conclusions. In the authors' opinion, open reduction provides the best possibility of normal facial development and return of axial movement in cases of AARF.