Natural History, Neuroradiological Workup, and Management Options of Chronic Atlantoaxial Rotatory Fixation Caused by Drug-Induced Cervical Dystonia
Table 2
Treatment options for patients with AARF, with respect to their specific effectiveness and pros and cons [10, 24–28].
Treatment options
Effectiveness
Pros
Cons
Conservative strategies
Anti-inflammatory drugs
Limited
No mechanical invasiveness
Gastrointestinal bleeding, allergic reactions
Cervical collar
Limited
Minimum invasiveness
Skin decubitus
Halter traction Glisson traction
Limited
Low invasiveness
Difficult airways access and feeding
Skull traction
Intermediate
Intermediate invasiveness
Pin site infection
Closed reduction under general anesthesia plus halo vest immobilization
High
Effective, even to chronic AARF
Pin site infection
Surgical strategies
Posterior approaches for C1-C2 fixation (various techniques: wiring, hooks, Magerl transarticular screws, and Harms technique with C1 lateral mass and C2 pars/pedicle/translaminar screws)
Very high
Effective in irreducible or recurrent subluxation, Fielding type 4 AARF
Damage to the vertebral artery, C2 nerve root ganglion, dural tears with cerebrospinal fluid leakage
Anterior approaches for C1-C2 fixation (various routes including lateral neck and transoral; various techniques: transarticular screws and plating)
Very high
Effective in cases with C1-C2 bony union
Damage to the hypoglossal nerve, internal carotid artery, and soft viscera Need for nasogastric feeding
