Anterior and posterior fixation for delayed treatment of posterior atlantoaxial dislocation without fracture

Yu, Hai; Malhotra, Karan; Butler, Joseph S.; Wu, Shi Qiang

doi:10.1136/bcr-2015-212436

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…Their hypothesis for the mechanism of injury was a combination of severe hyperextension and distraction. It has not been shown clinically or experimentally but the fact that 68% of patients have some facial injuries has made many authors to agree with proposed mechanism of injury [8]. Our patient had associated facial injuries which suggest that she might have had some hyper extension during the trauma.…”

Section: Mechanism Of Injury Of Posterior Atlantoaxial Dislocationsupporting

confidence: 50%

Traumatic Posterior Atlantoaxial Dislocation without Related Fractures of C1 - C2 in a Patient with Traumatic Brain Injury: Case Report and Literature Review

Moyo¹,

Musara²,

Kalangu³

2019

IJN

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It is exceptionally rare to have posterior atlanto axial dislocation without an associated atlas or odontoid fracture and very few cases have been reported in literature. We present a case of a 50 year old female pedestrian who was hit by car while crossing a road. She presented with a depressed level of consciousness and the Glasgow coma score of 12/15, pupils were equal and reactive to light and all limbs were moving equally. She had an extensive abrasion on the forehead which extended into scalp. CT scan showed a posterior dislocation of the atlas with respect of axis with no associated fractures of C 1 and C2. She had traumatic subarachnoid hemorrhage in the basal cisterns and multiple brainstem contusions. Closed reduction of the dislocation was done successfully under fluoroscopy guidance. MRI was done post reduction because funds were not available initially and it showed increased signal in the tectorial membrane and transverse and alar ligaments with mild cord oedema at the cervicomedullary junction. However, the patient post reduction began to deteriorate and eventually passed away before definitive treatment of her cervical-spine injury. The case is reported in view of its rarity and to review literature on this uncommon condition.

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Section: Mechanism Of Injury Of Posterior Atlantoaxial Dislocationsupporting

confidence: 50%

Traumatic Posterior Atlantoaxial Dislocation without Related Fractures of C1 - C2 in a Patient with Traumatic Brain Injury: Case Report and Literature Review

Moyo¹,

Musara²,

Kalangu³

2019

IJN

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“…Anderson and D'Alonzo classified odontoid fractures as type I, II, or III.Type II fractures have a watershed blood supply and have a high nonunion rate with risk for subsequent chronic pain, atlanto-axial instability, and neurological deterioration along with high mortality rates [12].…”

Section: Discussionmentioning

confidence: 99%

Recent Trend in Management of Odontoid Fracture

Bassiooni

Akef

Elhammady

2022

Benha Journal of Applied Sciences

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Background and aim: Odontoid fractures are among the most common spinal injuries of the elderly. Moreover, in patients older than 79 years, odontoid fractures occur even more frequently than all other spinal injuries together. Odontoid fractures account for 5-15 % of all cervical spine injuries in skeletally mature individuals. Methods: This study aimed to review and describe lines of treatment of odontoid process fracture with special reference to the recent treatment modalities. This is a review article, The search was performed in MEDLINE, Embase, Pubmed and CINAHL Plus in the same date range with the following mediacl terms: "Odontoid; Fracture; spinal injuries including articles from 2000 to 2021, Excluded articles from review are those of language other than English. Results and conclusion: Traumatic atlantoaxial dislocation with isolated odontoid fracture often encountered in clinical practice. Most of them reduce on extension, barring posterior dislocation. Skeletal traction helps, if they fail to reduce on extension. However, few patients, especially those presenting late, fail to reduce, despite traction. Previously, such patients with irreducible Traumatic atlantoaxial dislocation were managed with transoral odontoidectomy and posterior fusion. In the recent past, direct posterior reduction and fusion by intraoperative manipulation of the joints has been attempted successfully in a few cases of irreducible Traumatic atlantoaxial dislocation. Such a procedure is of advantage as it circumvents the transoral surgery. Non operative treatment include. Hard cervical orthosis for 6-12 weeks. halo vest immobilization for 6-12 weeks. Operative options include posterior C1-C2 fusion, Anterior odontoid osteosynthesis and transoral odontoidectomy.

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The comparison of clinical outcome of fresh type II odontoid fracture treatment between anterior cannulated screws fixation and posterior instrumentation of C1-2 without fusion: a retrospective cohort study

Wei

Tian

et al. 2018

J Orthop Surg Res

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Background: Recently, the excellent outcomes of temporary fixation of C1-2 without fusion in the treatment of odontoid fracture had been reported. It is still unclear if this technique could achieve the equivalent outcomes as the golden standard technique of anterior screw fixation. The objective of this study is to compare the clinical outcome of two treatments of fresh type II odontoid fracture: anterior cannulated screws fixation (ACSF) versus posterior instrumentation of C1-2 without fusion (PIWF). Methods: This is a retrospective study. This series included 28 males and 8 females, and the mean age was 41.5 years (range, 22 to 70 years). Eleven patients were treated with ACSF, and 25 patients with PIWF. For PIWF, the implants were removed after fracture union was confirmed at 0.75~1.5 years later. All patients underwent preoperative and serial postoperative clinical examinations at approximately 3 months, 6 months, and annually thereafter. The neck disability index (NDI) was used to assess the neck discomfort caused by the operation. The range of rotary motion was evaluated at each visit. All fractures were reassessed postoperatively with serial X-films and CT scans of the cervical spine at each follow-up visit, to evaluate screw position, fracture alignment, and fusion status. Results: All patients achieved immediate spinal stabilization after surgery, and none experienced neurologic deterioration. The follow-up periods ranged from 24 to 60 months. The average range of neck rotation was dramatically lost in PIWF after fixation (46°and 89°respectively in ACSF and PIWF), and recovered to 83°after the implant was removed. The NDI in PIWF was statistically higher than that in ACSF (5 and 13% respectively in ACSF and PIWF) after the first operation and decreased to 8% 1 year after the secondary operation. The fusion rates were 90.9 and 96% respectively in ACSF and PIWF. Both groups had a case of fracture non-union.

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Anterior and posterior fixation for delayed treatment of posterior atlantoaxial dislocation without fracture

Cited by 4 publications

References 14 publications

Traumatic Posterior Atlantoaxial Dislocation without Related Fractures of C1 - C2 in a Patient with Traumatic Brain Injury: Case Report and Literature Review

Traumatic Posterior Atlantoaxial Dislocation without Related Fractures of C1 - C2 in a Patient with Traumatic Brain Injury: Case Report and Literature Review

Recent Trend in Management of Odontoid Fracture

The comparison of clinical outcome of fresh type II odontoid fracture treatment between anterior cannulated screws fixation and posterior instrumentation of C1-2 without fusion: a retrospective cohort study

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