Atlantoaxial Rotatory Displacement in an Adult Patient With Parkinson’s Disease

Study Design: Case report. Objective: To describe the clinical presentation, diagnosis, management, and outcome of a rare case of adult atlantoaxial rotatory displacement (AARD) in a patient with Parkinson’s disease, and to highlight considerations for management in this patient population. Background: New development of AARD in adults is exceedingly rare, with limited reports in spinal literature. Most commonly associated with trauma involving forced cervical rotation, adult AARD has not previously been reported in a patient with Parkinson’s disease. Parkinson’s is associated with increased risks of musculoskeletal complications due to muscle rigidity and dystonia, which may have impacted treatment outcomes in our case. Case Report: A 72-year-old male with Parkinson’s disease presented with neck pain and a rotated head posture following a fall. He presented to clinic, after being discharged, with persistent pain and a Cock-Robin deformity. Review of imaging by the treating neurosurgeon confirmed a right-sided C1-C2 facet subluxation. A closed reduction was attempted in the OR, followed by hard collar immobilization. Initial closed reduction provided temporary relief, but the patient experienced immediate recurrence of the deformity despite strict collar compliance. Thus, the patient underwent repeat closed reduction with instrumented C1-C2 fusion. Surgical stabilization with led to a stable postoperative course without immediate complications and sustained symptom improvement. Conclusion: This is the first documented case of adult AARD in a patient with Parkinson’s disease. Nonoperative immobilization following closed reduction failed rapidly, potentially due to the muscular rigidity and dystonia associated with Parkinson’s. Given this risk, we recommend that surgeons consider performing concurrent closed reduction and atlantoaxial fusion rather than relying on postreduction immobilization alone in Parkinsonian patients with AARD.