{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T18:36:55Z","timestamp":1767033415395},"reference-count":13,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg A Cent Eur Neurosurg"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Purpose\u2003The atlantoaxial joint represents the most mobile joint complex within the spine, secured by ligaments and capsules. Integrity of the atlantoaxial joint is crucial with respect to the mobility of the head and the upper spine. Atlantoaxial rotatory dislocation is the most common type of injury within this joint in children and is characterized by a typical position of the head (cock robin position). Nevertheless, this type of injury is frequently overlooked. The purpose of the current study was threefold. First, the characteristics of the patients with atlantoaxial dislocation were identified. Next, we checked if the time to treatment did influence the type of treatment. Finally, we checked if the age of the child at the time of treatment influenced the type of treatment.<\/jats:p><jats:p>\n          Methods\u2003Forty-four children, who were treated consecutively due to atlantoaxial dislocation at a single spine center between September 1993 and October 2018, are analyzed retrospectively regarding age, sex, symptoms, etiology, time to diagnosis, time to treatment, and outcome.<\/jats:p><jats:p>\n          Results\u2003Forty-four children (30 girls, mean age 8.9 years) were included in the study. The cock robin head position was found in all of them, but neurological deficits were not found in any of them. In 21 patients, dislocation was caused by previous infection (Grisel's syndrome), whereas in 19 patients, dislocation was due to minor trauma. In 4 cases, etiology remained unknown. Mean time to sufficient treatment was 178 days. Eighteen patients received closed reduction and immobilization after 57 days at mean. Open reduction followed by temporary fixation was done in 12 patients after a mean time gap of 188 days. Bony atlantoaxial fusion was necessary in 14 children, who were diagnosed after 319 days on average. Invasiveness of treatment was dependent on the time delay between development of dislocation and treatment; a significant difference was found between invasiveness of treatment and time to treatment (Kruskal\u2013Wallis test, p\u2009&lt;\u20090,05). Moreover, older children were treated significantly more often with fusion than younger ones (\u03c7\n          2, p\u2009=\u20090,002).<\/jats:p><jats:p>\n          Conclusion\u2003Young girls are predisposed to incur an atlantoaxial rotatory dislocation, which usually occurs due to minor trauma or infection. The cock robin position is characteristic, but neurological deficits are not common. There is a need for early and sufficient treatment because delayed treatment necessitates more invasive treatment, thus leading to a complete loss of function of the most mobile joint within the spine. Finally, older children are predisposed to more invasive treatment strategies.<\/jats:p>","DOI":"10.1055\/s-0040-1712940","type":"journal-article","created":{"date-parts":[[2020,9,24]],"date-time":"2020-09-24T01:52:15Z","timestamp":1600912335000},"page":"001-008","source":"Crossref","is-referenced-by-count":9,"title":["Atlantoaxial Rotatory Dislocation: Delayed Diagnose Will Result in More Invasive Treatment Options"],"prefix":"10.1055","volume":"82","author":[{"given":"Tobias","family":"Pitzen","sequence":"first","affiliation":[{"name":"Center for Spine Surgery, Orthopedics and Traumatology, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Ruf","sequence":"additional","affiliation":[{"name":"Center for Spine Surgery, Orthopedics and Traumatology, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolin","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joerg","family":"Drumm","sequence":"additional","affiliation":[{"name":"Center for Spine Surgery, Orthopedics and Traumatology, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2020,9,23]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"E2","DOI":"10.3171\/2015.1.FOCUS14807","article-title":"Anatomy and biomechanics of the craniovertebral junction","volume":"38","author":"A J Lopez","year":"2015","journal-title":"Neurosurg Focus"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.1097\/BRS.0b013e3182793873","article-title":"Tensile failure properties of the perinatal, neonatal, and pediatric cadaveric cervical spine","volume":"38","author":"J F Luck","year":"2013","journal-title":"Spine"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1097\/MOP.0b013e32835bd4cf","article-title":"Cervical spine anomalies in children and adolescents","volume":"25","author":"H J Kim","year":"2013","journal-title":"Curr Opin Pediatr"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1097\/PEC.0000000000001023","article-title":"Atlantoaxial rotatory subluxation in children","volume":"33","author":"E C Powell","year":"2017","journal-title":"Pediatr Emerg Care"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1097\/BPO.0000000000000128","article-title":"Efficacy of nonfusion treatment for subacute and chronic atlanto-axial rotatory fixation in children","volume":"34","author":"M P Glotzbecker","year":"2014","journal-title":"J Pediatr Orthop"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"E252","DOI":"10.1097\/BSD.0000000000000563","article-title":"Transoral closed reduction of fixed atlanto-axial rotatory-subluxation (AARS) in childhood and adolescence","volume":"31","author":"D Jeszenszky","year":"2018","journal-title":"Clin Spine Surg"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s00586-004-0772-7","article-title":"Therapeutic options and results following fixed atlantoaxial rotatory dislocations","volume":"14","author":"M Weisskopf","year":"2005","journal-title":"Eur Spine J"},{"key":"ref8","first-page":"403","volume-title":"The Nervous System of the Human Body, Embracing Papers Delivered to the Royal Society on the Subject of Nerves","author":"C Bell","year":"1830"},{"issue":"20","key":"ref9","doi-asserted-by":"crossref","first-page":"2174","DOI":"10.1097\/00007632-199810150-00006","article-title":"Current management of pediatric atlantoaxial rotatory subluxation","volume":"23","author":"B R Subach","year":"1998","journal-title":"Spine"},{"issue":"22","key":"ref10","doi-asserted-by":"crossref","first-page":"2467","DOI":"10.1097\/00007632-200111150-00014","article-title":"Posterior C1-C2 fusion with polyaxial screw and rod fixation","volume":"26","author":"J Harms","year":"2001","journal-title":"Spine"},{"issue":"13","key":"ref11","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1097\/00007632-199807010-00010","article-title":"Transoral joint release of the dislocated atlantoaxial joints combined with posterior reduction and fusion for a late infantile atlantoaxial rotatory fixation. A case report","volume":"23","author":"S Goto","year":"1998","journal-title":"Spine"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/BF01400872","article-title":"Plate and screw fixation for atlanto-axial subluxation","volume":"129","author":"A Goel","year":"1994","journal-title":"Acta Neurochir (Wien)"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"688","DOI":"10.3171\/2013.8.SPINE1349","article-title":"Left-right axial rotation within C1-2 after implant removal","volume":"19","author":"T Pitzen","year":"2013","journal-title":"J Neurosurg Spine"}],"container-title":["Journal of Neurological Surgery Part A: Central European Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0040-1712940.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T23:32:27Z","timestamp":1609975947000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0040-1712940"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,23]]},"references-count":13,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2021,1,6]]},"published-print":{"date-parts":[[2021,1]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0040-1712940","relation":{},"ISSN":["2193-6315","2193-6323"],"issn-type":[{"value":"2193-6315","type":"print"},{"value":"2193-6323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,23]]}}}