Traumatic Vertical Atlantoaxial Instability in a Case of Atlanto-occipital Coalition

Weiner, Bradley K.; Brower, Richard S.

doi:10.1097/00007632-199705010-00019

Cited by 14 publications

(11 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other types of reduction, such as simple head extension, under fluoroscopic control or under axial compression, should be considered as an alternative to treat these cases. [15] 1996 Type III odontoid fracture Traction with lb 5 (1.87 kg) Weiner and Brower [19] 1997 Vertical dissociation (C1 occipitalization) Without traction…”

Section: Resultsmentioning

confidence: 99%

“…Since 1991, four cases of C1-C2 vertical instability and vertical dissociation have been described by three authors [8,15,19] (Table 1). Two of these cases presented a dissociation evident at the time of the trauma [8,19], and in the other two cases, dissociation only occurred after skull traction [8,15].…”

Section: Discussionmentioning

confidence: 99%

“…In 1997, Weiner and Brower [19] described a case of C1-C2 dissociation, created at the time of trauma, in a patient with congenital fusion between the C1 articular mass and the occipital condyle. The author considered distraction to be the mechanical basis of this lesion, and the fusion to be a factor of stress, developing a distraction overload between C1 and C2.…”

Section: Discussionmentioning

confidence: 99%

“…Weiner and Brower reported a case of reduced hyperdistraction using axial compression [19], and Jeanneret et al reported that traction under fluoroscopic control augments the safety of the method [11].…”

Section: Discussionmentioning

confidence: 99%

“…Without ligamentous integrity, even a simple cranial traction can not be counterbalanced and may cause overdistraction among the vertebrae, with its consequences. Recently, traumatic vertical (longitudinal) dissociation between C1 and C2 has been described [8,15,19]. It is extremely difficult to predict which patient will develop this lesion after being subjected to the traction.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Traumatic vertical atlantoaxial instability: the risk associated with skull traction. Case report and literature review

Botelho¹,

Palma

Abgussen

et al. 2000

European Spine Journal

View full text Add to dashboard Cite

IntroductionThe stability of the atlantoaxial motion segment is unique. The lack of typical vertebral bodies and the arrangement of articular facets without protection against horizontal gliding make the articular system dependent mostly on the ligaments. Anterior C1-C2 dislocation is a rare and severe lesion in distraction caused by a predominantly ligamentous lesion, leading to displacement of the atlas on the axis [13].Vertebral displacements require reduction for neural decompression and stabilization. The most frequently used reduction mode is traction. This creates an unusual kind of stress in the craniocervical transition, called vertical distraction. Without ligamentous integrity, even a simple cranial traction can not be counterbalanced and may cause overdistraction among the vertebrae, with its consequences. Recently, traumatic vertical (longitudinal) dissociation between C1 and C2 has been described [8,15,19]. It is extremely difficult to predict which patient will develop this lesion after being subjected to the traction. Here, we describe the case of a patient with traumatic anterior atlantoaxial dislocation who developed a vertical dissociation after skull traction, studying its complications and how they are related to the skull traction. Case reportA 16-year-old female patient, E.C.S., who was run over by a vehicle on 5 May 1997, was immediately taken to the first aid clinic of Conjunto Hospitalar do Mandaqui, São Paulo, Brazil.Cardiorespiratory arrest was detected upon examination. She was submitted to resuscitation attempts. The patient was hemodynamically stabilized, and remained in a coma without opening her eyes and with no motor response, with a score of 3 on the Glasgow coma scale. She was submitted to computed axial tomography (CAT) of the skull, which permitted visualization of the high cervical column and identification of an anterior C1-C2 dislocation (scout view) (Fig. 1). The CAT scan showed a wide separation between the odontoid and the anterior C1 arch and a minimal bilateral displaced fracture of the anterior C1 arch (Fig. 2).Abstract Traumatic overdistraction between C1 and C2 may occur when all the ligaments connecting C2 to the skull are ruptured, and may be manifested when an attempt to reduce C1-C2 subluxation is made by means of traction. We describe here the case of a patient with traumatic anterior atlantoaxial dislocation, who developed atlantoaxial vertical dissociation after skull traction using a Gardner-Halo with lb 4.02 (1.5 kg) of weight. The identification of patients who are susceptible to this complication is difficult. In this case, it might have been prevented by avoiding spinal traction. The aim of this report was to show that vertical dissociation may occur in C1-C2 anterior dislocation submitted to spinal traction, and that other forms of reduction must be considered to treat these pathologies and avoid this potentially fatal complication.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Traumatic vertical atlantoaxial instability: the risk associated with skull traction. Case report and literature review

Botelho¹,

Palma

Abgussen

et al. 2000

European Spine Journal

View full text Add to dashboard Cite

show abstract

Acute Traumatic Atlantoaxial Dislocation (AAD) in Adults

Suchomel

Frič

2010

Reconstruction of Upper Cervical Spine and Craniovertebral Junction

View full text Add to dashboard Cite

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

et al. 2013

View full text Add to dashboard Cite

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.

show abstract

Traumatic Vertical Atlantoaxial Instability in a Case of Atlanto-occipital Coalition

Abstract: Vertical atlantoaxial instability has not been described previously. From the somewhat subtle radiographic findings, one might underestimate the severity of the neurologic damage. Aggressive work-up and management of this injury is suggested to avoid potential further necrologic sequelae.

Cited by 14 publications

References 7 publications

Traumatic vertical atlantoaxial instability: the risk associated with skull traction. Case report and literature review

Traumatic vertical atlantoaxial instability: the risk associated with skull traction. Case report and literature review

Acute Traumatic Atlantoaxial Dislocation (AAD) in Adults

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

Contact Info

Product

Resources

About