Posterior atlantoaxial dislocation without fracture

Yoon, Do Heum; Yang, Kyung‐Soo; Kh, Kim; Oh, Sung Han

doi:10.3171/spi.2003.98.1.0073

Cited by 16 publications

(11 citation statements)

References 9 publications

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“…Closed reduction, however, is not without its dangers. Since the supporting ligaments have ruptured, there is less control of the cervical spine and excessive distraction carries the risk of fatal injury 1 14. Authors have previously carried out traction with the patient awake in order to detect any neurological changes 7.…”

Section: Discussionmentioning

confidence: 99%

Anterior and posterior fixation for delayed treatment of posterior atlantoaxial dislocation without fracture

Malhotra

Butler

et al. 2015

BMJ Case Reports

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Posterior atlantoaxial dislocation (PAAD) without fracture of the odontoid process is a rare injury. Authors have variously reported closed or open reduction, followed by either anterior or posterior fixation, but there is no consensus on best treatment. We present a particularly unstable case of PAAD. Open reduction through a retropharyngeal approach with odontoidectomy was required for reduction. Anterior fixation with transarticular lag screws was required prior to posterior fixation with pedicle screws. Despite non-compliance with postoperative immobilisation, imaging at 20-month follow-up confirmed solid fusion. The patient is pain-free with a good range of movement of the neck and has returned to a manual job. Our case had a greater degree of instability than was previously reported, which necessitated 360° fixation. This is the first reported case of this treatment strategy, which provided a very stable fixation allowing fusion despite early movement and without causing undue stiffness.

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Section: Discussionmentioning

confidence: 99%

Anterior and posterior fixation for delayed treatment of posterior atlantoaxial dislocation without fracture

Malhotra

Butler

et al. 2015

BMJ Case Reports

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“…Yoon et al . in their study adopted an operation-assisted reduction to avoid over-distraction of the spinal cord,[9] since it is difficult to judge the amount of traction which may lead to death due to over-distraction of the C1-C2 complex. [2122] Flexion/extension maneuver, adopted for the odontoid process to slip back into the osteo-ligamentous ring of atlas, also has a great potential to injure the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

“…Posterior dislocation without any associated fracture of odontoid is exceedingly rare, with only 11 cases reported so far to the best of our knowledge. [23456789101112] We present posterior atlantoaxial dislocation without odontoid process fracture or neurological deficit.…”

Section: Introductionmentioning

confidence: 99%

Traumatic posterior atlantoaxial dislocation without related fractures of C1–C2

Kambali

Anand

Priyamargavi

et al. 2013

IJOO

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Posterior dislocation without any associated fracture of odontoid is exceedingly rare and only 11 cases have been reported so far. A 32 year old male presented with pain, stiffness in neck, difficulty in breathing, associated lacerations on face and deformity of mandible and inability to open mouth. His plain radiographs, CT scan, MRI demonstrated a posterior dislocation of the atlas with respect of axis and a flake of bone from odontoid process on CT scan. He was successfully managed by closed reduction, C1C2 lateral mars pedicular screw stabilization and inter facetal fusion with synthetic bone graft substitute. At 10 months followup he had lost only 30° cervical rotation. The case is reported in view of rarity and to discuss the treatment rationale.

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“…First, it is very difficult to determine how much force applied is appropriate and overdistraction of the C1-C2 complex can lead to immediate death of the patient [2,13]. For fear of this lethal complication of closed reduction, Yoon et al [19] adopted an operation-assisted reduction in their case to avoid overdistraction of the spinal cord. Second, the traction procedure must be done under repeated fluoroscopic control and continuous neurological monitoring which are not always available at hand.…”

Section: Discussionmentioning

confidence: 99%

Posterior atlantoaxial dislocation without fracture and neurologic deficit: a case report and the review of literature

et al. 2009

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Traumatic posterior atlantoaxial dislocation without related fracture of the odontoid process is very rare, and only ten cases have been previously reported. The objective of this paper was to describe a case of traumatic posterior atlantoaxial dislocation without related fracture of the odontoid process, and its management with atlantoaxial transarticular screw fixation and bony fusion through an anterior retropharyngeal approach, and to review the relevant literature. The patient's medical and radiographic history is reviewed as well as the relevant medical literature. Posterior atlantoaxial dislocation was confirmed in a 48-year-old male struck by an automobile through conventional radiography, computed tomography and magnetic resonance imaging. No related fracture of the odontoid process or neurological deficit was found in this patient. Transarticular screw fixation of the atlantoaxial articulation through anterior retropharyngeal approach was performed after several unsuccessful attempts of closed reduction. At the latest follow-up, the lateral cervical spine radiography in flexion and extension demonstrated no instability of the atlantoaxial complex 21 months after the operation. In conclusion, patients with posterior atlantoaxial dislocation without fracture may survive with few or no-long term neurological deficit. Routine CT and MRI of the cervical spine should be carried out in patients with head or neck trauma to prevent missing of this rare clinical entity. Transarticular screw fixation of the atlantoaxial articulation through anterior retropharyngeal approach is safe and useful in case the management of dislocation is unsuccessful under closed reduction.

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Posterior atlantoaxial dislocation without fracture

Cited by 16 publications

References 9 publications

Anterior and posterior fixation for delayed treatment of posterior atlantoaxial dislocation without fracture

Anterior and posterior fixation for delayed treatment of posterior atlantoaxial dislocation without fracture

Traumatic posterior atlantoaxial dislocation without related fractures of C1–C2

Posterior atlantoaxial dislocation without fracture and neurologic deficit: a case report and the review of literature

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