Journal of the Chinese Medical Association
Volume 73, Issue 4 , Pages 222-224, April 2010

Treatment of Atlantoaxial Rotatory Fixation With Botulinum Toxin Muscle Block and Manipulation

  • Chia-Hung Lin

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Taichung, Taiwan, R.O.C.
    • ,
  • Chun-Jung Chen

      Affiliations

    • Department of Education and Research, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.
    • ,
  • Chuan-Mu Chen

      Affiliations

    • Department of Life Science, National Chung-Hsing University, Taichung, Taiwan, R.O.C.
    • ,
  • Su-Lan Liao

      Affiliations

    • Department of Education and Research, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.
    • ,
  • Shue-Ling Raung

      Affiliations

    • Department of Education and Research, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.
    • ,
  • Sen-Wei Tsai

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Taichung, Taiwan, R.O.C.
    • Department of Life Science, National Chung-Hsing University, Taichung, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Sen-Wei Tsai, Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, 160, Section 3, Chung-Kang Road, Taichung 407, Taiwan, R.O.C.

Received 22 June 2009; received in revised form 18 January 2010

Article Outline

Slippage after reduction of atlantoaxial rotatory fixation (AARF) is usually treated with repeated cervical traction and brace immobilization. To date, no data have been published on the management of muscle spasm during treatment. Here, we describe the case of a 7-year-old girl with AARF for 1 month who visited our hospital for treatment. During physical examination, spasm of the sternocleidomastoid muscle was noted. The patient was treated with manipulative reduction, and slippage after reduction was managed with botulinum spasticity block of the sternocleidomastoid and splenius capitis muscles, and repeated manipulation. Cervical orthosis immobilization with a rehabilitation program of isometric contract–relax exercise for the neck was conducted for 3 months. The subject had full recovery from AARF at 1-year follow-up. This report demonstrates that, in selected cases of slippage after reduction from AARF, conservative management with manipulation under anesthesia is a good method, and the muscle components may play a crucial role in AARF.

Key Words:  atlantoaxial rotatory fixation , botulinum toxin , manipulation

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PII: S1726-4901(10)70047-2

doi:10.1016/S1726-4901(10)70047-2

Journal of the Chinese Medical Association
Volume 73, Issue 4 , Pages 222-224, April 2010

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