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Fixed rotatory dislocation due to bilateral facet subluxation

Axial CT through the ring of C1 and the body of C2 showing fixed rotatory dislocation due to bilateral facet subluxation. The right C1 facet has subluxed anteriorly with respect to the right C1 facet. The left C1 facet has subluxed posteriorly with respect to the left C1 facet. The patient’s head would be turned to the left and tilted to the right. Note that the spinal canal is diminished in diameter. The ring of C1 has moved forward and rotated to the left. The dens of C2 appears close to the right C1 lateral mass. Note that the spinal canal remains capacious, without imminent spinal cord compression. “Od” refers to the odontoid process. “VA” is adjacent to the left foramen transversarium of the ring of C1, through which the vertebral artery passes. (Contributed by Dr. David Choi.)

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Associated Disorders

  • Ankylosing spondylitis
  • Chiari malformation
  • Cleidocranial dysplasia
  • Down syndrome
  • Ehlers-Danlos type IV
  • Grisel syndrome
  • Head and neck infection
  • Inflammatory arthritides
  • Marfan disease
  • Morquio syndrome (mucopolysaccharidosis type IV)
  • Primary cervical dystonia
  • Reiter syndrome
  • Systemic lupus erythematosus
  • Trauma
  • Tuberculosis
  • Tuberculous spondylitis