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Subclinical Chronic Atlanto-Occipital Rotatory FixationA Case Report
Kazuya Oshima, MD, PhD1; Hironobu Sakaura, MD, DMSc2; Motoki Iwasaki, MD, DMSc2; Kunihiro Oka, MD, PhD2; Kazuomi Sugamoto, MD, PhD2; Hideki Yoshikawa, MD, PhD2
1 Department of Orthopaedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan. E-mail address: ko-osk@umin.ac.jp
2 Department of Orthopaedic Surgery (H.S., M.I., K.O., and H.Y.), Department of Orthopaedic Biomaterial Science (K.S.), Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan

JBJS Case Connector, 2012 Aug 22;2(3):e41 1-3. doi: 10.2106/JBJS.CC.K.00145
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Cases of symptomatic atlanto-occipital rotatory subluxation and dislocation caused by trauma, tumor, inflammatory disease, or congenital anomaly have been previously reported1-3. These conditions can be highly unstable and result from osteoligamentous disruption between the occipital bone (Oc) and the axis (C2)4,5. To the best of our knowledge, there have been no reports of cases of asymptomatic chronic atlanto-occipital rotatory fixation (AORF). While there are patients who may be asymptomatic neurologically and only present with neck pain, we report an extremely rare case of subclinical chronic AORF with previous symptomatic atlantoaxial rotatory fixation (AARF). The patient and her parents were informed that data concerning the case would be submitted for publication, and they provided consent.
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