Chronic Irreducible C1–C2 Rotatory Subluxation Presenting as Painful Torticollis in a Child Managed with Posterior Lateral Mass Fixation: A Case Report Sachlang Debbarma , Chirag Sharma , Ajoy Baishya ,

Introduction: Atlantoaxial rotatory subluxation (AARS) is an uncommon yet important cause of painful torticollis in children. While most acute cases respond to conservative management, delayed diagnosis may result in fixed and irreducible deformity requiring surgical stabilization. Chronic irreducible cases are rare and pose significant management challenges. Case Report: A 9-year-old girl presented with persistent painful torticollis for 6 weeks following minor trauma. Clinical examination revealed a classic cock-robin posture with severely restricted cervical motion. Computed tomography confirmed fielding type II C1–C2 rotatory subluxation. Despite adequate conservative management, the deformity remained irreducible. Failure of conservative treatment and fixed deformity necessitated surgical intervention. Posterior C1 lateral mass and C2 pedicle screw fixation was performed. Intraoperative reduction was achieved, followed by rigid stabilization and fusion. Conclusion: Chronic irreducible AARS in children requires early recognition and timely surgical stabilization. Posterior C1–C2 lateral mass fixation provides reliable correction and excellent functional outcomes. Keywords: Atlantoaxial rotatory subluxation, C1–C2 instability, pediatric torticollis, posterior lateral mass fixation, fielding Type II, cervical spine surgery