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Advanced Trauma Life Support (ATLS) has resulted in a significant increase in the number of radiological examinations, and thus an associated increase in the number of suspected cases of traumatic atlanto-axial rotatory fixation (AARF). Rotatory fixation of the cervical spine is a rare but serious condition in the adult that presents with torticollis or "cock-robin position", which is irreducible. It is often associated with arthritides, infection, or Grisel's syndrome in children but is rarely associated with trauma. The diagnosis is a clinical one with torticollis, high neck pain, and no neurological abnormality. Plain x rays should include a "peg view" and a lateral cervical spine. Traumatic AARF is suspected radiologically when odontoid lateral mass asymmetry is present in the open mouth view. The increase in the suspected diagnosis on plain x rays has led to a parallel increase in the number of computed tomography (CT) scans of C1-C2 taken to diagnose AARF.
The aim of our study was to retrospectively evaluate the imaging appearances in a series of adult patients who underwent cervical spine CT after atlanto-axial asymmetry was shown on radiography. We then assessed the clinical outcome of this group of patients and established a protocol for appropriate investigation of atlanto-axial asymmetry.
MATERIALS AND METHODS
We retrospectively reviewed CT records of adult patients with a history of acute neck trauma from the period 1999-2001 at our institution. All patients had been referred through our Accident and Emergency (A&E) Department. None of these patients had any other injuries apart from the suspected neck injury. Atlanto-axial asymmetry was suspected on the basis of a standard cervical x ray series showing evidence of odontoid lateral mass asymmetry. There was no evidence of an increase in the atlanto-dens interval on the lateral view in any patient. All patients went on to have a CT scan of C1-C3 with 2 mm axial cuts from the occiput to C3. Seven patients underwent dynamic CT scanning.
RESULTS
We included a total of 29 patients (16 men, 13 women; age range 21-44 years) in this study. The mechanisms of injury were: road traffic accident (n = 21), sports...