Traumatic posterior Atlanto-axial dislocation: case report of an atypical C1-C2 dislocation with an anterior arch fracture of C1

Abstract

BackgroundAn atypical case of a traumatic posterior C1-C2 dislocation with an anterior arch fracture of C1 is reported. A novel conservative treatment for this rare lesion is described.Case presentationAn eighty-nine-year-old male fell off a ladder at home and presented with an acute traumatic cervical spine trauma, which we believe involved a distraction mechanism. The patient was neurologically intact; he denied any weakness, numbness or paresthesia. A preoperative CT-scan demonstrated a posterior dislocation with an anterior arch of C1 fracture. Conservative management was elected. Reduction was achieved by closed manual reduction under general anesthesia. A postoperative CT demonstrated a complete reduction of the atlanto-axial dislocation.ConclusionBased on this case report and relevant literature, we present an unusual lesion of the upper cervical spine treated nonoperatively with closed manual reduction under general anesthesia. To date, there is no available consensus for the management of these lesions.

Traumatic posterior dislocation of atlanto-axial joint with anterior arch fracture in the patient of atlanto-occipital assimilation: A case report

“…Therefore, the measurement of ADI either shows a negative value or does not accurately reflect the status of the patient's dislocation. Ghailane et al mentioned the meaning of negative ADI as an indicator that the dens of C2 migrate anteriorly and not posteriorly against the spinal cord [ 6 ].…”

“…Ghailane et al [ 6 ] reported successful C1 anterior arch fracture treatment accompanying posterior AAD using closed reduction and rigid brace application. Unlike our case, in the report by Ghailane et al, congenital anomalies such as AOA were not accompanied, and the degree of posterior translation of C1 observed on CT was limited to the posterior margin of the C2 facet.…”

“…Depending on the etiology of AAD, it can be broadly categorized into traumatic, congenital, and inflammatory causes [ [2] , [3] , [4] , [5] ]. Among them, traumatic AAD is a relatively uncommon condition, often observed in association with life-threatening circumstances [ [6] , [7] , [8] ]. Posterior AAD typically arises from a traumatic mechanism involving hyperextension of the head and neck and may be accompanied by an anterior arch fracture of the atlas [ 7 ].…”

Traumatic Posterior Atlantoaxial Dislocation With an Associated Fracture

“…The posterior surgical approach was favored in 88% of surgically treated cases. The median postoperative follow-up time was 9 months (Interquartile range, [6][7][8][9][10][11][12]. Additional details are shown in Table 2.…”

“…Traumatic posterior atlantoaxial dislocation with fracture (TPAD) is an extremely rare entity encountered in the emergency department, with a limited number of cases reported in the literature 1–22 . The first TPAD case was reported in 1924 by Nicholson et al, 18 describing 50-year-old laborer struck by a falling tree.…”