Spontaneous atlantoaxial subluxation associated with tonsillitis

Atlantoaxial subluxation is a rare condition and requires a high index of suspicion to diagnose and treat in order to avoid long-term sequelae. Here, we present a case of late presentation of a nontraumatic rotatory subluxation of the atlantoaxial joint or atlantoaxial rotatory subluxation. A 17-year-old girl presented 3 months after the onset of nonspecific upper limb sensory symptoms which eventually settled spontaneously. Initial conservative management by the general practitioner had no effect. Computed tomography scanning revealed a Type 1 dislocation with rotatory fixation and with <3 mm anterior displacement of the atlas. The management of Type 1 subluxations is usually conservative with bed rest, oral nonsteroidal anti-inflammatory drugs, muscle relaxants, reduction (if required) and immobilization with a soft collar. This patient, however, required more invasive management due to the late presentation and slightly greater fixed deformity. As the subluxation could not be reduced with active manipulation, Gardner-Wells tongs with traction were applied. She then progressed to a pinned HALO, cyber neck support and subsequently an aspen collar which was eventually weaned off over a few weeks. The outcome and radiologic alignment at follow-up was satisfactory.