Concomitant atlantoaxial and atlanto-occipital rotatory dislocation in children: Radiological features, diagnostic pitfalls, and long-term outcome

• Main Authors: Paul A Koljonen, Kenneth MC Cheung
• Format: Article
• Language: English
• Published: SAGE Publishing 2021-05-01
• Series: Journal of Orthopaedic Surgery
• Online Access: https://doi.org/10.1177/23094990211015502

While the pathological manifestation of atlantoaxial rotatory dislocation has been well described in the medical literature, the combined dislocation of the atlantoaxial and atlanto-occipital joints, or OAARD – short for occipital-atlantoaxial rotatory dislocation – is a condition which has been poorly elucidated and probably underdiagnosed. We believe that the pathogenesis of combined atlantoaxial and atlanto-occipital dislocation is most likely a result of untreated atlantoaxial rotatory dislocation leading to chronic secondary compensation measures occurring at the occiput-C1 joints. Unique clinical and radiological features lead to difficulty in diagnosis, and conventional treatment algorithms may not apply. This paper describes a combination of clinical and radiological features which can help clinicians correctly diagnose and treat OAARD.