Halter Traction for the Treatment of Atlantoaxial Rotatory Fixation

J Bone Joint Surg Am. 2022 Feb 2;104(3):229-238. doi: 10.2106/JBJS.21.00831.


Background: Atlantoaxial rotatory fixation (AARF) comprises a spectrum of abnormal rotational relationships between C1 (atlas) and C2 (axis). We aimed to evaluate the efficacy and long-term clinical outcomes of halter traction in treating patients diagnosed with primary AARF.

Methods: We included patients <18 years of age who presented with new-onset painful torticollis, neck pain, and sternocleidomastoid muscle spasm, had an AARF diagnosis confirmed by use of 3-dimensional dynamic computed tomography, received in-hospital cervical halter traction under our treatment protocol, and were followed for ≥12 months. Radiographic and long-term clinical outcomes were analyzed.

Results: A total of 43 patients (31 male and 12 female; average age of 7.9 years) satisfied the inclusion criteria. There were 5 acute, 6 subacute, and 32 chronic cases. The mean duration of initial symptoms prior to treatment was 12.1 weeks. Thirty-seven (86.0%) of the patients experienced previous minor trauma, and 6 (14.0%) had a recent history of upper-respiratory infection (Grisel syndrome). The mean duration of in-hospital traction was 17.6 days. The mean follow-up period was 8.5 years. Forty-two (97.7%) of the patients achieved normal cervical alignment after treatment. One patient (2.3%) had recurrence and received a second course of halter traction, with cervical alignment restored without any surgical intervention. No neurological deficits were noted during or after the treatment. No major complications were observed.

Conclusions: Normal anatomy and restoration of cervical alignment can be achieved by cervical halter traction in most cases of AARF.

Levels of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Adolescent
  • Atlanto-Axial Joint / diagnostic imaging*
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Joint Dislocations / complications
  • Joint Dislocations / diagnostic imaging
  • Joint Dislocations / therapy*
  • Male
  • Torticollis / diagnostic imaging
  • Torticollis / etiology
  • Torticollis / therapy*
  • Traction / methods*
  • Treatment Outcome