Atlantoaxial Joint Interlocking Following Type II Odontoid Fracture Associated with Posterolateral Atlantoaxial Dislocation: a Case Report and Review of Published Reports

Abstract

A rare case of atlantoaxial lateral mass joint interlocking secondary to traumatic posterolateral C1,2 complete dislocation associated with type II odontoid fracture is herein reported and the impact of atlantoaxial joint interlocking on fracture reduction discussed. A 72-year-old man presented with traumatic atlantoaxial lateral mass joint interlocking without spinal cord signal change, the diagnosis being confirmed by radiography and 3-D reconstruction digital anatomy. Posterior internal fixation was performed after failure to achieve closed reduction by skull traction. After many surgical attempts at setting had failed because of interlocking of the lateral mass joints, reduction was achieved by compressing the posterior parts of the atlantal and axial screws. Odontoid bone union and C1,2 posterior bone graft fusion were eventually obtained by the 12-month follow-up. The patient had a complete neurological recovery with no residual neck pain or radiculopathy.

Treatment of irreducible atlantoaxial dislocation using one-stage retropharyngeal release and posterior reduction

“…Various etiologies, [1][2][3][4] such as congenital os odontoideum, old dens fracture, and transverse ligament rupture, can cause IAAD and result in neck pain, dizziness, and occipitocervical cord compression. There are various methods to treat IAAD, including transoral odontoidectomy and posterior decompression and fixation, 6 transoral atlantoaxial reduction plate internal fixation, [7][8][9] transoral atlantoaxial release and posterior internal fixation, [10][11][12] and direct posterior reduction and fixation.…”

“…Irreducible atlantoaxial dislocation (IAAD) has various etiologies [1][2][3][4][5] and can result in occipitocervical cord compression. IAAD treatment is challenging for spine surgeons, and various procedures have been used.…”

Traumatic C1–2 posterolateral dislocation with dens fracture, injury of the transverse atlantal ligament, and unilateral facet fracture with subluxation of C6–7

“…1 ). Computed tomography (CT) scans confirmed the dislocation with type II dens fracture (Anderson and D’Alonzo classification) [ 2 ] and revealed a unilateral facet fracture with subluxation and lamina fracture of C6–7 (Fig. 2 ).…”

Acute traumatic lateral atlantoaxial dislocation associated with locked atlas lateral mass and odontoid process fracture: A clinical case study and literature review

“…[1,2] Traumatic atlantoaxial dislocation combined with a locked atlas lateral mass and an odontoid process fracture is a complex injury which is extremely rare among upper cervical injuries. [3] There have been few reports published and no agreement has yet been established on the method of determination of the level of severity or on the appropriate management of this injury. [3,4] This study reports on a success surgical outcome and presents a clinical case study from our experience in managing a traumatic lateral atlantoaxial dislocation combined with locked atlas lateral mass and type II odontoid fracture.…”

“…[3] There have been few reports published and no agreement has yet been established on the method of determination of the level of severity or on the appropriate management of this injury. [3,4] This study reports on a success surgical outcome and presents a clinical case study from our experience in managing a traumatic lateral atlantoaxial dislocation combined with locked atlas lateral mass and type II odontoid fracture. This work has been reported in accordance with SCARE criteria [5].…”