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CGMH Chia Ni , Lin

Atlantoaxial Rotatory Fixation: New Diagnostic Paradigm And A New Classification Based On Motion Analysisi Using Computed Tomographic Imaging. CGMH Chia Ni , Lin. Contents. AARF Anatomy Patients and Method Result Discussion. Atlantoaxial Rotatory Fixation (AARF).

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CGMH Chia Ni , Lin

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  1. Atlantoaxial Rotatory Fixation:New Diagnostic Paradigm And A New Classification Based On Motion Analysisi Using Computed Tomographic Imaging CGMH Chia Ni , Lin

  2. Contents • AARF • Anatomy • Patients and Method • Result • Discussion

  3. Atlantoaxial Rotatory Fixation(AARF) • The unique configuration of the atlantoaxial complex lends itself to behave as the main rotational pivot of the cervical spine • often painful, rotational deformity that we call atlantoaxial rotatory fixation (AARF) because of its apparent “fixed” state to voluntary or involuntary correction. • typically present with torticollis with the head in the “cock-robin” position

  4. Anatomy

  5. The predictable relationship between C1 and C2 • single motion phase (from C1° = 0 to 23°), when only C1 turns • double motion phase (from C1° = 24 to 65°) when both C1 and C2 are turning in the same direction • Unison motion phase (from C1° = 65 to 90°)

  6. Patient Exclusion Criteria • The postinfectious cases associated with otological or pharyngeal infections • Torticollis patients with congenital bony anomalies of the occipital-atlas-axis complex. • Within the posttraumatic group, cases with concomitant atlanto-occipital and other cervical fracture dislocations and spinal cord injury without radiographic abnormality.

  7. Clinical information

  8. Image technique • All angle measurements :axial CT scans using bone algorithms • the lower half of the clivus to the base of the C3 body, 3 mm thick without overlap at a 0-degree gantry angle (120kV, 70 mA, with a 2-second scan time) • Mild sedation

  9. Angle measurements

  10. Normal template

  11. Group 1 patients

  12. Type I AARF

  13. Type I AARF(Patient 4, Group 1)

  14. Motion Curve of all Group 1 Patients

  15. Group 2 patients

  16. Type II AARF(Patient 5, Group 2)

  17. Type II AARF

  18. Motion Curve of all seven Group 2 Patients

  19. Group 3 patients

  20. Type III AARF(Patient 8, Group 3)

  21. Type III AARF

  22. Motion Curve of all nine Group 3 Patients

  23. Group 4 patients

  24. Motion Curve of all 14 Group 4 Patients

  25. Group 5 patients

  26. Motion Curve of all five Group 5 Patients

  27. Rough diagnostic domains of the three type of AARF

  28. Case 1

  29. Case 2

  30. Summary

  31. Diagnostic paradigm of AARF

  32. Discussion • The more horizontal the curve, the more locked are the two bones • Diagnostic curve.

  33. Management algorithm of AARF

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