A case report of manipulation under anesthesia of posttraumatic type II occipital-atlantoaxial rotatory subluxation in a 4-year-old girl

Objective: To discuss a case of occipital-atlantoaxial rotatory subluxation successfully treated with manipulation under general anesthesia. Clinical Features: A 4-year-old girl presented to the Taichung Veterans General Hospital with acute torticollis and neck stiffness for 1 week after she had fallen. Although some nonsteroidal anti-inflammatory drugs had been prescribed for her, her neck still tilted to the right side and her chin inclined to the left side. There were no neurological signs, no significant pain if she did not move her neck and head, and no muscular hypertonocity. There was painful guarding in the right stemocleidomatoid muscle when manipulation was attempted. Three-dimensional computer tomography revealed uneven joint space between the C1 anterior arch and odontoid process and confirmed a type II atlantoaxial rotatory subluxation. Intervention and Outcome: Manipulation under anesthesia was performed by a medical doctor trained in manual therapy. The low-velocity, right rotational manipulation applied to the occiput included axial traction. The neck symptoms were relieved immediately after treatment. Conclusion: Under general anesthesia, manipulation may be a good method for treating noncomplicated type II atlantoaxial rotatory subluxation. Additional investigations may be necessary to evaluate the treatment effect.