Traumatic atlantoaxial dislocation with an odontoid fracture: A rare and potentially fatal injury

Zitouna, Khaled; Riahi, Hend; Lassoued, Nabil Ben; Selmene, Mohamed Amine; Barsaoui, Maher; Drissi, Ghassen

doi:10.4103/ajns.ajns_214_19

Cited by 10 publications

(2 citation statements)

References 18 publications

(19 reference statements)

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“…Atlantoaxial dislocation is a loss of joint stability between the C1 (atlas) and C2 (axis) spine and could be associated with type II odontoid fracture [1] . Pathological process of the C1 and C2 spine could lead to odontoid fracture and atlantoaxial dislocation [2] .…”

Section: Introductionmentioning

confidence: 99%

Atlantoaxial dislocation with associated type II odontoid fracture in adolescent with cervical spondylitis tuberculosis: A case report

Tobing

Makabori

2023

International Journal of Surgery Case Reports

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Section: Introductionmentioning

confidence: 99%

Atlantoaxial dislocation with associated type II odontoid fracture in adolescent with cervical spondylitis tuberculosis: A case report

Tobing

Makabori

2023

International Journal of Surgery Case Reports

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“…There are only a few published cases of AA dislocation associated with type III odontoid fracture. [2][3][4][5][6][7][8][9] These injuries can be complex, involving bony, ligamentous, and vascular structures, as well as spinal cord injury. 10 Nondisplaced type III odontoid fractures are generally treated nonoperatively but can progress to nonunion and AA instability.…”

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confidence: 99%

Extended tulip cervical reduction screws to restore alignment in traumatic atlantoaxial dislocation after type 3 odontoid fracture: illustrative case

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Zhang

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Traumatic atlantoaxial rotatory subluxation after type 3 odontoid fracture is an uncommon presentation that may require complex intraoperative reduction maneuvers and presents challenges to successful instrumentation and fusion. OBSERVATIONS The authors report a case of a 39-year-old female patient who sustained a type 3 odontoid fracture. She was neurologically intact and managed in a rigid collar. Four months later, she presented again after a second trauma with acute torticollis and type 2 atlantoaxial subluxation, again neurologically intact. Serial cervical traction was placed with minimal radiographic reduction. Ultimately, she underwent intraoperative reduction, instrumentation, and fusion. Freehand C1 lateral mass reduction screws were placed, then C2 translaminar screws, and finally lateral mass screws at C3 and C4. The C2–4 instrumentation was used as bilateral rod anchors to reduce the C1 lateral mass reduction screws engaged onto the subluxated atlantodental complex. As a final step, cortical allograft spacers were inserted at C1–2 under compression to facilitate long-term stability and fusion. LESSONS This is the first description of a technique using extended tulip cervical reduction screws to correct traction-irreducible atlantoaxial subluxation. This case is a demonstration of using intraoperative tools available for the spine surgeon managing complex cervical injuries requiring intraoperative reduction that is resistant to traction reduction.

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Management of post-traumatic craniovertebral junction dislocation: A PRISMA-compliant systematic review and meta-analysis of casereports

2020

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Although historically considered fatal, with the advent of improved pre-hospital care, traumatic dislocation of the craniovertebral junction (CVJ) has been increasing in prevalence in neurosurgical centers. As more survivors are reported each year, a timely review with meta-analysis of their management seems necessary. PRISMA checklist was followed step by step. PubMed and Web of Science databases were searched using words “craniovertebral junction dislocation” and their corresponding synonyms. Study eligibility criteria included research studies from 2015 onwards that delineated adult and pediatric patients with confirmed post-traumatic atlantooccipital dislocation (AOD) or atlantoaxial dislocation (AAD) who survived until proper treatment. Of 1475 initial records, 46 articles met eligibility criteria with a total of 141 patients with traumatic CVJ dislocation. Of the patients, 90 were male (63.8%). Mean age of the cohort was 33.3 years (range 1–99 years). Trauma that most often led to this injury was road traffic accident (70.9%) followed by falls (24.6%). The majority of authors support posterior instrumentation of C1-C2 (45.2%) especially by means of Goel-Harms method. At mean follow-up of 15.4 months (range 0.5–60 months), 27.2% of treated patients remained neurologically intact. Of initially symptomatic, 59% improved, 37% were stable, and 4% deteriorated. Instrumenting the occiput in cases of pure AAD was associated with lower chance of neurological improvement in chi-square test (p = 0.0013) as well as in multiple linear regression (β = − 0.3; p = 0.023). The Goel-Harms C1-C2 fusion is currently the most frequently employed treatment. Many survivors remain with no deficits or improve, rarely deteriorate. Involving the occiput in stabilization in cases of AAD without AOD might be related with worse neurological prognosis.

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Traumatic atlantoaxial dislocation with an odontoid fracture: A rare and potentially fatal injury

Cited by 10 publications

References 18 publications

Atlantoaxial dislocation with associated type II odontoid fracture in adolescent with cervical spondylitis tuberculosis: A case report

Atlantoaxial dislocation with associated type II odontoid fracture in adolescent with cervical spondylitis tuberculosis: A case report

Extended tulip cervical reduction screws to restore alignment in traumatic atlantoaxial dislocation after type 3 odontoid fracture: illustrative case

Management of post-traumatic craniovertebral junction dislocation: A PRISMA-compliant systematic review and meta-analysis of casereports

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