Posterior atlantoaxial dislocation without odontoid fracture

Chaudhary, R. K.; Chaudhary, Kshitij; Metkar, Umesh; Rathod, Ashok; Raut, Abhijit; Sanghvi, Darshana

doi:10.1007/s00256-007-0439-7

Cited by 21 publications

(30 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…PAAD is a very significant injury and is thought to have a very high mortality rate 2 4. Patients who do survive are likely to have some preserved ligamentous stability holding the OP locked against the anterior border of the atlas.…”

Section: Discussionmentioning

confidence: 99%

“…Authors have previously managed this injury by closed reduction using a method described by Wong et al as discussed above 2 6 8. However, in these cases, the patients were definitively managed within 48 h of injury before much swelling/scarring could occur.…”

Section: Discussionmentioning

confidence: 99%

“…However, in these cases, the patients were definitively managed within 48 h of injury before much swelling/scarring could occur. Between 7 and 10 kg of traction has been used to successfully reduce PAAD 2 3 8. In these cases, the dislocation was stable once reduced and could be managed in a hard collar or cervicothoracic orthosis for a period of 3 months.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Malhotra

Butler

et al. 2015

BMJ Case Reports

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Malhotra

Butler

et al. 2015

BMJ Case Reports

View full text Add to dashboard Cite

show abstract

“…In fact, four patients who were managed with closed reduction achieved stability without fusion or internal fixation [3,[10][11][12]. Although the integrity of the transverse ligament was investigated in the case of Chaudhary et al [3] using MRI technique of and an intact transverse ligament was even confirmed, the other six cases were all supplemented with posterior fusion and internal fixation for fear of residual instability or incomplete reduction (Table 1).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2009

View full text Add to dashboard Cite

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.

show abstract

“…Most of the patients are neurologically intact [1,2]. Closed reduction and collar immobilization has been reported to be successful in a few cases though intact transverse axial ligament (TAL) is a prerequisite for conservative management [1,3]. Most of the previously reported cases have been managed with C1-C2 fusion [1].…”

Section: Introductionmentioning

confidence: 99%

Atlanto-axial subluxation with cervical myelopathy operated with occipital C2 fusion: A case report

et al. 2017

View full text Add to dashboard Cite

Background: Atlantoaxial subluxation with cervical myelopathy is a rare condition that can occur mainly by trauma followed by Rheumatoid arthritis, Grisel syndrome, Down’s syndrome and various other metabolic disorders. It is characterized by excessive movement of atlas (C1) over axis (C2) either by bony or ligamentous abnormality. Due to its laxity the spinal cord may get damaged and cause neurologic symptoms. Reduction and fixation is needed for such instability. Case Report: This 55-year-old gentleman was apparently all right 4 years back when he gradually developed difficulty in walking and imbalance. Bilateral Babinski sign was positive, All deep tendon reflexes were brisk; muscle tone was increased with clasp-knife spasticity present in all four limbs. Ankle and patellar clonus was present bilaterally. His X-ray cervical spine showed C1-C2 subluxation in flexion and extension views. Magnetic resonance imaging (MRI) of Cranio-vertebral junction. Mild subluxation of atlantoaxial joint (3.1 mm) with posterior displacement of dens causing narrowing of bony cervical spinal canal with reduced distance between posterior aspect of dens of C2 and anterior aspect of posterior arch of C1 vertebrae was noticed. Atlas was also slightly displaced anteriorly in relation to baso-occiput. We managed this patient with occipital cervical fusion after reduction from a posterior approach using screws and rods construct and fusion with bone graft from iliac crest. Post operatively the patient was able to walk without any support and tone of the muscles in lower limb decreased, no tingling or numbness are present, no signs of local infection or inflammation. Conclusion: We suggest to operate atlanto-axial subluxation and cervical myelopathy with occipital C2 fusion.

show abstract

Posterior atlantoaxial dislocation without odontoid fracture

Cited by 21 publications

References 12 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

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

Atlanto-axial subluxation with cervical myelopathy operated with occipital C2 fusion: A case report

Contact Info

Product

Resources

About