[Atypical dislocated dens fracture type II with rotational atlantoaxial luxation after a riding accident]

Severe traumatic atlantoaxial dislocation and type III odontoid fracture treated with occipitocervical fixation: a case report

The combination of atlantoaxial joint dislocation accompanied by an odontoid process fracture is exceptionally rare, with only a few cases reported. The estimated frequency of these cases is < 2% of all upper cervical spine injuries. In this report, the authors describe an unusual case of traumatic atlantoaxial dislocation with a type III odontoid fracture in a 44-year-old male patient. Before the diagnosis, the patient had a history of seeking a masseur for a neck massage. Subsequently, the patient underwent occipitocervical stabilization to address the underlying condition. This procedure aims to treat the instability between the skull and cervical spine and should be considered in the treatment planning if the patient's anatomy suits it.

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

Background

An 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 presentation

An 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.

Conclusion

Based 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 Atlantoaxial Dislocation with an Odontoid Fracture: A Rare and Potentially Fatal Injury

Traumatic dislocation of the atlanto-axial joint in combination with an odontoid fracture remains a rare entity. Beaucause of its instability, it's alsoo a seriuous injury. A fatal outcome is feared especially in elderly. We report a case of 74-year-old man who presented with neck pain Confusion and spastic tetraparesia after a low energy trauma. Radiographs and computed tomography demonstrated a C1C2 dislocation with odontoid fracture. After an unsuccessful attempt at closed reduction with halo traction, a surgical stabilisation was performed using a posterior approach. Death was occured in early postoperative due to respiratory distress.

Traumatic Atlantoaxial Lateral Subluxation With Chronic Type II Odontoid Fracture: A Case Report

Background

We report a case of an elderly patient who was diagnosed with lateral atlantoaxial subluxation with type II odontoid fracture, an extremely uncommon upper cervical spine injury that has not been previously reported in the literature to the knowledge of the authors.

Methods

An 87-year-old male reported to the emergency room following a syncopal episode after sustaining a fall. He complained of dizziness, fatigue, disruption of vision and audition, and worsening neck pain. Computed tomographic scans were positive of partial dislocation of the C1 relative to C2 and chronic fracture of dens classified as type II according to the Anderson and D'Alonzo classification system. Magnetic resonance imaging further revealed large fracture pannus tissue at the level of the dens, reducing the space in the spinal cord. There was no evidence of spinal cord injury. Atlas-axis fusion with instrumentation was performed to manage the injury. A review of the classification, occurrence, and management of upper cervical spine surgeries was performed.

Results

An acute injury to a previously unrecognized type II odontoid fracture with partial C1-C2 dislocation was identified as a rare upper cervical spine injury and classified based on the Anderson and D'Alonzo and Fielding and Hawkins classification systems. The decision was made to perform instrumented spinal fusion by inserting mass screws into C1, pars screws into C2, and locking rods to realign the vertebral bodies and address the atlantoaxial instability. Follow-up scans indicated good postsurgical reduction and fixation, including resolution of the pannus overgrowth without direct intervention.

Conclusions

Lateral atlantoaxial subluxation with chronic type II fracture of the dens constitutes a rare injury of the upper cervical vertebrae. Posterior instrumented spinal fusion was used to effectively manage the injury, leading to reabsorption of retro-odontoid pannus tissue.

Can Break-Dance Break Your Neck? C1/C2 Luxation with a Combined Dens Fracture Without Neurological Deficits in an 11-Year Old Boy After a Break-Dance Performance

Atlantoaxial dislocation in children is a very rare condition. We present the case of a dislocation happened during a break-dance maneuver. The purpose of this report is describing dangers of break-dancing and discussing the treatment we chose. The patient was followed up until 12 months after surgery. Magnetic resonance imaging and computed tomography of the cervical spine were evaluated. Translaminar fixation of C1/C2 had been performed after manual reposition under X-ray illumination. After a 12-month follow-up, the patient shows a stable condition without neurological dysfunction. He is not allowed to perform any extreme sports.

C1 posterior arch screw as an auxiliary anchor in posterior reconstruction for atlantoaxial dislocation associated with type II odontoid fracture: a case report and review of the literature

INTRODUCTION

Although pedicle or lateral mass screws are usually chosen to fix atlantoaxial (C1-C2) instability, there is an increased risk for vertebral artery (VA) injury when used in patients with bone or arterial anomalies or osteoporotic bone. Here we report the C1 posterior arch screw as a new technique for upper cervical fixation.

CASE DESCRIPTION

A 90-year-old man complained of upper cervical pain after falling in his house. The initial computed tomography (CT) scan showed C1-C2 posterior dislocation with a type II odontoid fracture. The patient underwent C2 fracture reduction and posterior C1-C2 fixation. On the right side of C1, because lateral mass screw placement could cause injury to the dominant VA considering a risk in oldest-old osteoporotic patients, a posterior arch screw was chosen instead as an auxiliary anchor. An intralaminar screw was placed on the right side of C2 because a high-riding VA was observed. A lateral mass screw and a pars interarticularis screw were placed on the left side of C1 and C2, respectively. Ten months later, the odontoid fracture had healed, with normal anatomical alignment. Although the patient experienced slight weakness when spreading his bilateral fingers, his overall condition was good.

DISCUSSION AND EVALUATION

We have presented a novel technique using C1 posterior arch screws for the fixation of a C1-C2 dislocation. Such a screw is an alternative to the C1 lateral mass screw in patients who are at risk for a VA injury because of anomalous bone and arterial structures or poor bone quality.

CONCLUSIONS

Although there have been few comparable studies, and the long-term outcome is unknown, fixation with a posterior arch screw could be a beneficial choice for surgeries involving the upper cervical region.

Posterior atlantoaxial dislocation complicating odontoid fracture without neurologic deficit: a case report and review of the literature

Traumatic posterior atlantoaxial dislocation associated with odontoid fracture is extremely rare, with only eight cases reported thus far in the English literature. This report concerns a 47-year-old female who presented with considerable pain and stiffness in the neck without a neurologic deficit after injury due to a fall. Radiographs, computed tomography, and magnetic resonance imaging demonstrated a posterior dislocation of the atlas with respect to the axis with an odontoid fracture. No cord compression or intramedullary cord signal abnormalities were detected at the level of the atlantoaxial dislocation. A pedicle screw fixation/fusion was performed via a posterior approach following successful closed reduction.

Traumatic atlantoaxial dislocation with odontoid fracture: A case report

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.