Surgical Treatment for Atlantoaxial Rotatory Fixation in an Adult With Spastic Torticollis: A Case Report
Surgical Treatment for Atlantoaxial Rotatory Fixation in an Adult With Spastic Torticollis: A Case Report
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成人痉挛性斜颈寰枢椎旋转固定的手术治疗：病例报告
DOI：
10.1016/j.jocn.2020.03.017
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发表时间：
2020
期刊：
影响因子：
2
通讯作者：
Nakagawa K
中科院分区：
文献类型：
--
作者：
Akiyama Y;Takahashi H;Saito J;Aoki Y;Nakajima A;Sonobe M;Akatsu Y;Yamada M;Yanagisawa K;Shiga Y;Inage K;Orita S;Eguchi Y;Maki S;Furuya T;Akazawa T;Koda M;Yamazaki M;Ohtori S;Nakagawa K
在没有任何创伤的成人中，寰枢椎旋转固定(AARF)是一种极其罕见的情况。在此，我们报告一位患有痉挛斜颈的成人，对现有的寰枢椎旋转固定术进行手术治疗。一位50岁的男性在来我们医院就诊的6周前发现了无任何原因的斜颈，在那里他有一周的严重颈部疼痛的病史。根据局部和影像表现，我们诊断他患有现有的Fiding分类I型AARF。经过3周的Glisson牵引，AARF没有减少。因此，在他初次就诊3个月后，我们进行了C1-C2后路融合手术。术后即刻CT检查显示小关节半脱位减轻，但斜颈症状无改善，左侧胸锁乳突肌高张致颈椎中下段脊柱侧弯。在神经学诊断为痉挛性斜颈的情况下，术后2周开始应用安定，术后2个月开始左侧胸锁乳突区注射肉毒杆菌毒素。结果，术后3个月，他的斜颈症状明显改善。随访2年，斜颈无复发，C1-C2椎板完全融合。如果AARF的诊断延迟，应考虑成人AARF的手术治疗。此外，术后对痉挛性斜颈进行适当的治疗，可获得良好的治疗效果。
Atlantoaxial rotatory fixation (AARF) in an adult without any trauma is an extremely rare condition. Here we report a case of surgical treatment for existing atlantoaxial rotatory fixation in an adult with spastic torticollis. A 50-year-old man had become aware of torticollis without any cause of injury 6 weeks before he visited our hospital, where he presented with a one-week history of severe neck pain. Based on the local and imaging findings, we diagnosed him as having existing AARF of Fielding classification type I. The AARF was not reduced by 3 weeks of Glisson traction. Thus, we performed C1–C2 posterior fusion surgery 3 months after his initial visit. Although CT findings just after surgery showed that the C1-2 facet subluxation was reduced, the complaint of torticollis was not improved, with scoliosis at the middle to lower cervical level because of left sternocleidomastoid hypertonia. Administration of diazepam was initiated 2 weeks after surgery and botulinum toxin injections to the left sternocleidomastoid were added 2 months after surgery under the neurological diagnosis of spastic torticollis. As a result, the complaint of his torticollis was significantly improved 3 months after surgery. There were no relapses of the torticollis and complete fusion of the C1–C2 laminae was observed at the 2-year final follow-up. Surgical treatment for AARF in an adult should be considered if the diagnosis of AARF is delayed. In addition, appropriate treatment for spastic torticollis applied after surgery resulted in a favorable outcome of this case.