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Spontaneous Atlantoaxial Rotatory Fixation in Old Age After Cerebral Infarction: Case Report

Mori, Kanji, MD; Hukuda, Sinsuke, MD; Katsuura, Akitomo, MD; Saruhashi, Yasuo, MD; Asajima, Shuzo, MD

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Study Design. Case report of spontaneous Fielding and Hawkins Type I atlantoaxial rotatory fixation in a 78-year-old man after hemiplegia and homonymous hemianopsia caused by cerebral infarction.

Objectives. To describe a case of spontaneous atlantoaxial rotatory fixation in old age and review previous adult cases of atlantoaxial rotatory fixation without fracture.

Summary of Background Data. Atlantoaxial rotatory fixation in adults is a relatively rare finding and is mainly caused by trauma. To the author’s knowledge, there has been no previous report of spontaneous atlantoaxial rotatory fixation in old age.

Methods. The patient’s head was fixed in a 40° left-rotated position. Left hemiplegia and homonymous left-side hemianopsia developed due to cerebral infarction. Computed tomography of the cervical spine clearly showed rotatory fixation of the atlas on the axis.

Results. Successful reduction was obtained after 1 day of skull traction.

Conclusions. It was hypothesized that repeated left-rotational stress due to homonymous hemianopsia loaded to the atlantoaxial joint caused abnormal laxity of the joint.

From the Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan.

Acknowledgment date: September 15, 1999.

Acceptance date: December 15, 1999.

Address reprint requests to

Kanji Mori, MD

Department of Orthopaedic Surgery

Shiga University of Medical Science

Tsukinowa-cho, Seta, Otsu

Shiga, 520-2192, Japan

E-mail: kanchi@bell.shiga-med.ac.jp

Device status category: 1.

Conflict of interest category: 12.

© 2000 Lippincott Williams & Wilkins, Inc.