Atlantoaxial Rotatory Fixation

  • Spiros G. Pneumaticos
  • George K. Triantafyllopoulos


Atlantoaxial Rotatory Fixation is a rare condition occuring more commonly in children than in adults, in which there is fixed rotation of C1 on C2. The fixation may occur within the range of normal rotation, may occur with subluxation, or may occur with dislocation. Clinically the patients will have ipsilateral rotation and contralateral tilt of the head in relation to the lateral mass of C1. The contra-lateral sternocleidomastoid may be spastic. Fielding and Hawkins in 1977 classified atlantoaxial rotatory subluxation into four types basing their classification on the amount and direction of the midsaggital plane anteroposterior atlantoaxial displacement. This classification was presented in a time when more precise imaging tools were not commonly available thus the measurement of the atlas to dens interval as shown on a lateral X-ray is very important.


Lateral Mass Odontoid Process Anterior Displacement Normal Rotation Transverse Ligament 
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  1. 1.
    Fielding JW, Stillwell WT, Chynn KY, Spyropoulos EC. Use of computed tomography for the diagnosis of atlanto-axial rotatory fixation. A case report. J Bone Joint Surg Am. 1978;​60(8):1102–4.PubMedGoogle Scholar
  2. 2.
    Fielding JW, Hawkins RJ. Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am. 1977;59(1):37–44.PubMedGoogle Scholar
  3. 3.
    Pang D, Li V. Atlantoaxial rotatory fixation: part 3-a prospective study of the clinical manifestation, diagnosis, management, and outcome of children with alantoaxial rotatory fixation. Neurosurgery. 2005;57(5):954–72; discussion -72.PubMedCrossRefGoogle Scholar
  4. 4.
    Smith MD, Phillips WA, Hensinger RN. Fusion of the upper cervical spine in children and adolescents. An analysis of 17 patients. Spine (Phila Pa 1976). 1991;16(7):695–701.CrossRefGoogle Scholar
  5. 5.
    Subach BR, McLaughlin MR, Albright AL, Pollack IF. Current management of pediatric atlantoaxial rotatory subluxation. Spine (Phila Pa 1976). 1998;23(20):2174–9.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  • Spiros G. Pneumaticos
    • 1
  • George K. Triantafyllopoulos
    • 2
  1. 1.3rd Academic Department of Trauma and Orthopaedics, School of MedicineUniversity of AthensAthensGreece
  2. 2.3rd Academic Department of Trauma and OrthopaedicsKAT HospitalAthensGreece

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