Traumatic atlantoaxial subluxation, posterior transfacet fixation: a case report

Abstract

Cervical spine injuries are often described as catastrophic events in neurological terms, with very low survival rate. Lesions to C3-C7 segment are the most common (about 80%) followed by segment C1-C2 (20%). The cervical spine injuries are of great importance, both by severity as the neurological implications. It is important to consider that among cervical traumas that do not present neurological damage at the time of the accident, 10% have deficits later, so all cervical trauma should be considered as potential spinal cord traumas, until the evolution of the case shows that definitively there is no spinal cord or nerve root damage. Cases have been reported with both atlantooccipital and atlantoaxial dislocations without neurological deficit, so these lesions went unnoticed in the emergency services. Some of the events to be considered at the time of the accident are suboccipital pain on axial skull pressure and spontaneous stiffness of the patient's neck. Dysphagia, pain on palpation of the anterior neck and a visible increase of prepharyngeal mass can also be observed, which is why it is important to keep the suspicion of craniocervical trauma in all patients who have these symptoms and carry out the relevant tests. This paper presents a case of post-traumatic atlantoaxial dislocation, which showed no neurological deficit at the time of the accident, but was later presented, as well as the surgical procedure carried out.

Defining and measuring objective and subjective spinal stiffness: a scoping review

“…Stiffness is a clinically relevant symptom reported by patients and has implications for patient-relevant health outcomes in the rehabilitation setting. In the initial evaluation of patients presenting with spinal stiffness, consideration should be given to the possibility of serious causes such as inflammatory disease, 2,141 degenerative conditions, 173,175 infection (bacterial or viral), 160,268 cancer, 152 trauma, 4,155,156 intracranial pathology, 162,171 and postoperative complications. [129][130][131][132][133] The symptom of stiffness and its relationship to other clinical manifestations is essential to differentiate between a benign condition and pathophysiology.…”