Atlantoaxial dislocation in Spastic Cerebral Palsy: A Case Report

Abstract

Atlantoaxial dislocation (AAD) is a rare but potential condition in children, with great complexity combined with spastic cerebral palsy (CP). This case report present clinical radiological features, and functional outcomes of a 12-year-old girl with spastic CP and AAD who underwent a structured physiotherapy program. The purpose to evaluate the effectiveness of non-surgical, exercise-based rehabilitation approach in improving cervical stability, functional abilities, and motor performance. A comprehensive 12-week physiotherapy intervention was implemented, emphasizing graded cervical mobility exercises, core strengthening, scapular stabilization, postural correction, and balance training. Progressions aligned with clinical tolerance. Standardized tools including  Pediatric Balance Scale (PBS), Manual Ability Classification System (MACS), and goniometric cervical ROM assessment were used pre- and post-intervention to quantify functional gains. MRI imaging before and after rehabilitation changes in atlantoaxial distance. Significant improvements were observed following intervention. Cervical ROM increased by 20–25%, accompanied by notable gains in muscle strength across upper and lower limbs. The atlantoaxial distance decreased from 5.4 mm to 3.2 mm, reflecting radiological improvement. PBS improved from 25 to 43, and MACS level improved from Level 3 to Level 2. Enhanced postural control, balance, and independence in daily activities were maintained. This case demonstrates a structured, goal-oriented physiotherapy program serve as effective conservative strategy for managing pediatric AAD associated with spastic CP. Targeted strengthening and stabilization may offer viable alternative to surgery in select cases.