Traumatic atlantoaxial dislocation with odontoid fracture: A case report

Abstract

We are reporting the one-year follow-up for a case of traumatic atlantoaxial dislocation associated with an odontoid fracture. This injury combination is rare and serious because of its resulting instability. After an unsuccessful attempt at closed reduction with traction, an open reduction with occipitocervical fixation was performed using a posterior approach. Based on our experience and a review of the published literature, the method for managing such an injury is discussed. If closed reduction with traction is successful, subsequent treatment is based on the algorithms for isolated odontoid fractures. If the closed reduction fails, surgical treatment consists of an open reduction using a posterior or lateral retropharyngeal approach, and then fixation of C1-C2, which is the key procedure.

Occipitocervical Fusion and Posterior Fossa Decompression in Neglected Jefferson Fracture-Dislocation of Atlas Associated With Odontoid Peg Fracture: A Case Report

“…This approach, however, does not provide good exposure of the articular processes, and muscle layers must be detached and reflected laterally, which further increases the risk of venous bleeding. 1 Our surgical plan includes posterior fossa decompression and C1 arch laminectomy following posterior spinal instrumentation using a combination of pedicle and lateral mass screws. This management plan, which was usually used in cases of Chiari malformation, 15 tumor decompression, 16 and atlantoaxial subluxation of a chondroplastic patient with narrow foramen magnum, 17 proved to be a good option in managing this particular combination of injury compared with the more complicated ventral procedures.…”

“…The resulting instability further increases the fatal nature of this injury. 1 Atlantoaxial fracture-dislocation may cause cervical cord injury and death in the immediate postinjury period or in a delayed fashion. 2,3 The survival rate of these cases can only be increased through early diagnosis, immediate immobilization, meticulous monitoring, and early reduction and fixation of the fracture.…”

Traumatic atlantoaxial subluxation, posterior transfacet fixation: a case report

“…1,2,8 C1-C2 luxations are rare in adults, occurring in <1% of all spinal injuries and around 20% of lesions of the cervical spine. 1,3,9,10 Atlantoaxial subluxation is rare, and even more so without fracture of the dens (odontoid process) of the axis. As a result, it can sometimes be overlooked.…”

“…Where there is suspicion, imaging studies, plain AP and lateral radiography should be carried out, with their respective measurements, and even more importantly, computed axial tomography with 3D reconstruction. 1,[3][4][5]9,13 Early diagnosis is essential, as a longer period between the lesion and its reduction is correlated with higher rates of recurrence and failure of the reduction through non-surgical techniques 14 We believe that simple radiographic measurements (ADI and Powers Index) of the cervical spine can help in the interpretation of anomalies in segment C1/C2, as in this case, where both measurements showed values compatible with C1/C2 disassociation, as well as helping the team of the emergency unit avoid overlooking these potentially devastating entities.…”

“…1,5,7 Although there have been few published cases, the treatment by this type of pathology is fixation with transfacet screws, a technique that provides stability and adequate anatomical reduction. 1,[5][6][7]9,10,15…”