Traumatic Atlantoaxial Distraction Injury

Carroll, Eben A.; Gordon, Bradley S.; Sweeney, Colleen; Joy, Stephen E.; Connolly, Patrick J.

doi:10.1097/00007632-200102150-00026

Cited by 27 publications

(14 citation statements)

References 9 publications

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“…Nonetheless, to avoid over diagnosis of distraction injuries, it is essential to identify any cup-shaped joint space that might be present. Our literature review found only nine cases [11][12][13] of vertical traumatic AAD, three isolated vertical AAD with no bony lesions, one case associated with an atlas lesion [17], and five with odontoid fractures [18][19][20] (Table 1). Gonzalez et al [22] described six cases of vertical AAD diagnosed in 1 year: one patient died very quickly, another case was a child with a conservative treatment, three cases were isolated AAD, and the last one was associated with a C1 arch fracture.…”

Section: Discussionmentioning

confidence: 98%

“…This injury can also occur without any trauma; this is most likely in cases of pre-existing anomalies of the C1-C2 joint, such as rheumatoid arthritis or ankylosing spondylitis [16], which can lead to basilar invagination by weakening the occipitocervical ligaments and facet capsules. A few cases have been associated with other superior cervical spine fractures [17][18][19][20]. It must be noted that pure anterior [6], vertical, or lateral [10] AAD is more likely to occur in odontoid pseudarthrosis or malformation or rheumatoid arthritis, and rotatory AAD in children [21].…”

Section: Introductionmentioning

confidence: 99%

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Trauma of the upper cervical spine: focus on vertical atlantoaxial dislocation

et al. 2013

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Purpose Traumatic ligament injuries of the craniovertebral junction, either isolated or associated with bone avulsion or fracture, often lead to death. These injuries are rare and underrated but are increasingly seen in emergency departments due to the improvement in initial on-scene management of accidents. Vertical atlantoaxial dislocation (AAD) is a specific lesion that was barely reported. Based on our experience, our goal was to systematically investigate the prevalence and prognosis of traumatic vertical AAD and discuss its management. Methods All cervical CT scans performed at our institution between 2006 and 2010 for cervical trauma in adults were retrospectively reviewed. Based on the measurement of lateral mass index (LMI), defined as the gap between C1 and C2 articular facets, we identified three cases of traumatic vertical AAD in 300 CT scans. Their medical records were investigated.Results The incidence of vertical AAD was 1 % in the exposed population. One case was an isolated vertical AAD and two were associated with a type II odontoid fracture. We report the first case in the literature of unilateral vertical AAD. Two patients died rapidly; the survivor was treated with occipitocervical fixation. Specific maneuvers were used for immobilization and reduction. Conclusions This study found a not insignificant incidence of vertical AAD and a high lethality rate. LMI appears to be a relevant radiological criterion for this diagnosis, for which traction is contraindicated. Associated neurological or vascular damage should be suspected and investigated. In our experience, spinal surgical fixation is required because of major instability.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Trauma of the upper cervical spine: focus on vertical atlantoaxial dislocation

et al. 2013

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“…Most of the cases with neurological deficit is associated with odontoid fracture while our case was rare with no association of any fracture. Most would agree that nonoperative treatment has little, if any, role in the definitive treatment of occipital cervical dislocations or dissociations [6]. Halo vest immobilization is most often used as a temporary means of stabilizing or reducing injuries until surgery can be safely performed.…”

Section: Discussionmentioning

confidence: 99%

“…Halo vest immobilization is most often used as a temporary means of stabilizing or reducing injuries until surgery can be safely performed. Longitudinal traction is contraindicated [6]. In an anecdotal case review, one group reported successful treatment of a patient with a distractive atlantoaxial injury in a halo vest [6].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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Cervical Trauma

Özsarlak

2007

Spinal Imaging

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Traumatic Atlantoaxial Distraction Injury

Abstract: In this case, conservative management of a ligamentous C1-C2 injury was effective. At 5 years after trauma the patient was without sequelae. This outcome is in contrast to previous management of injuries of this type, all of which involved surgical intervention.

Cited by 27 publications

References 9 publications

Trauma of the upper cervical spine: focus on vertical atlantoaxial dislocation

Trauma of the upper cervical spine: focus on vertical atlantoaxial dislocation

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

Cervical Trauma

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