How to treat atlantoaxial subluxation in children?

With the development of society, the incidence of various cervical diseases is getting higher and higher, which is mainly caused by people's bad living habits, such as working at a desk for a long time, or often lowering their heads to play with mobile phones, etc. Compared with adults, children's necks are very fragile, so children often suffer from atlantoaxial subluxation, which is a very harmful neck disease. The treatment method is introduced below.

Treatment of atlantoaxial subluxation in children:

The choice of treatment method should be based on the condition of the lesion. Traction reduction and plaster fixation are appropriate in the acute phase. Occipital-mandibular traction is sufficient to achieve the purpose of reduction. Only when it fails should skull traction be considered. For those who are stable after traction reduction, atlantoaxial fixation is performed.

Treatment instructions:

The goal of treatment is to restore the motion function of the cervical spine and prevent deformity. Factors affecting treatment include the duration of torticollis deformity, the degree of rotational dislocation, ligament injury, and nerve damage. Torticollis that lasts less than a week can often heal itself by wearing a neck collar and resting in bed for a week. If reduction is not possible, traction treatment is required. Patients with torticollis deformity for more than 1 week but less than 1 month can be treated with chin-occipital traction or skull traction. When active rotation range of motion is equal on both sides.

Stop pulling. Then use a cervical collar to fix it for 6 weeks. If torticollis lasts for more than 1 month, skull traction should be performed. The initial traction weight for severely ill children is 3.2 kg, and then it is increased by O every 3 to 5 days. 5～O． 9kg, maximum weight is 6.8kg. The starting traction weight for adults is 6.8kg and the maximum weight is 9.1kg.

After traction was continued for 2 to 3 weeks, a head collar vest was used for external fixation for 3 months. But sometimes the dislocation lasts too long and traction cannot reduce it. Surgical treatment may be considered.

Indications for surgical treatment include: atlantoaxial instability; re-dislocation after reduction; incomplete reduction; transverse ligament rupture; anterior dislocation of the atlas; nerve damage and deformity for more than 3 months. Bone traction was performed before surgery to minimize reduction. Most authors advocate the use of Gallie wire technique or Brooks wire technique for atlantoaxial fusion. Sometimes there may be compensatory reverse subluxation of the occipito-atlantal joint. Some authors believe that this indicates instability of the occipito-atlantal joint and advocate in situ occipitocervical fusion. Some authors advocate retaining the function of the occipito-atlantal joint and only fusing the atlas and axis, and using a head collar vest for fixation after surgery. During the reduction of atlantoaxial dislocation by traction, care should be taken to avoid aggravating the occipito-atlantal joint dislocation, otherwise it will lead to catastrophic consequences.

The atlantoaxial joint accounts for about 50% of the cervical spine's rotation function. Therefore, after fusion of the atlantoaxial joint, the cervical spine will lose some of its rotation function. However, from a clinical perspective, atlantoaxial joint fusion does not have a significant effect on the function of the patient's cervical spine. For old atlantoaxial rotational subluxation, if the joint has not been reduced, traction reduction or open reduction followed by bone grafting and fusion can be considered.