ORIGINAL ARTICLE
Odontoid lateral mass asymmetry: do we over-investigate?
Department of Orthopaedics, St Vincent’s University Hospital, Dublin, Ireland
Correspondence to:
Correspondence to:
J A Harty
The Mews, 61 Serpentine Ave, Ballsbridge, Dublin 4, Ireland; jaharty{at}hotmail.com
Objectives: This study aimed to evaluate the necessity for further radiological investigation in patients with suspected traumatic rotatory subluxation of the atlanto-axial complex on plain radiography following acute cervical trauma and outline guidelines for assessment of patients with atlanto-axial asymmetry on plain radiography.
Methods: A retrospective review of all patients who had undergone atlanto-axial CT scanning as a result of radiographic C1–C2 asymmetry following cervical spine trauma. The plain x ray and CT images were reviewed retrospectively and correlated with the clinical presentation and outcome.
Results and conclusion: Records of 29 patients (16 men, 13 women; age range 21–44 years) were reviewed. All patients were found to have atlanto-odontoid asymmetry on the initial plain x ray. CT images of none of the patients revealed rotatory subluxation. Ten patients (32%) were found to have congenital odontoid lateral mass asymmetry. All patients were treated conservatively without any further intervention. On review, in 19 patients the orientation of the x ray beam in combination with head rotation was found to be at fault. Approximately 1050 trauma cervical spine x rays were taken in the department where this study was conducted over the period 1999–2001. This study identified 10 patients out of a total of 29 as having congenital odontoid lateral mass asymmetry. This represents approximately 1% of the patients attending the emergency department. Thus congenital odontoid lateral mass asymmetry should be considered in the differential diagnosis following acute cervical trauma.
Keywords: atlanto-axial; rotatory fixation
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