In seventeen cases of irreducible atlanto-axial rotatory subluxation
(here called fixation), the striking features were the delay in diagnosis
and the persistent clinical and roentgenographic deformities. All patients
had torticollis and restricted, often painful neck motion, and seven young
patients with long-standing deformity had flattening on one side of the
face. The diagnosis was suggested by the plain roentgenograms and tomograms
and confirmed by persistence of the deformity as demonstrated by
cineroentgenography. Treatment included skull traction, followed by
atlanto-axial arthrodesis if necessary. Of the thirteen patients treated by
atlanto-axial arthrodesis, eleven had good results, one had a fair result,
and one had not been followed for long enough to determine the result. Of
the remaining four patients, one treated conservatively had not been
followed for long enough to evaluate the result, two declined surgery, and
one died while in traction as the result of cord transection produced by
further rotation of the atlas on the axis despite the traction.