Surgery for nontraumatic atlantoaxial rotatory fixation after COVID-19 in a 17-year-old girl: a case report.

We herein describe a case of atlantoaxial rotatory fixation (AARF) following COVID-19 in a healthy, 17-year-old, female, high school student. After the COVID-19 infection improved, the patient experienced neck pain. After 1 week, the patient was unable to turn her neck. Her local doctor diagnosed the patient with AARF. She wore a cervical soft collar and underwent Glisson traction for 2 weeks. However, as the AARF did not improve, computed tomography (CT) was performed. Reconstructed CT showed that the morphology of the C1/2 facet joint was asymmetrical. We manually repaired her neck position under general anesthesia, and she wore a halo fixation for a month. However, the patient neck position dislocated slightly when the traction was released. Hence, we performed C1/2 posterior fusion and bone graft. She was discharged home 10 days postoperatively and was able to perform her daily activities without any problems. One year later, CT images showed no bony bridge at the C1/2 facet joint, and the morphology of the C1/2 facet joint did not change from that before surgery. As no remodeling is expected after the end of the growth phase, early surgical treatment of AARF could be considered if conservative treatment is ineffective.