Expert’s comment concerning Grand Rounds case entitled “Vertebral artery injury and severely displaced odontoid fracture: the case for early reduction” (by M.P. Sullivan, J.D. McCormick, V. Arlet)

Abstract

This is an interesting case report describing an excellent clinical result achieved by indirect decompression of the vertebral artery by ''early'' reduction with traction in a trans-odontoid atlanto-axial luxation fracture [1]. The trans-odontoid luxation fracture is a highly unstable traumatic lesion of the atlanto-axial complex most often associated with an Anderson type II fracture of the odontoid (Fig. 1). In many cases, this luxation can already be suspected on the conventional X-rays by the position of the atlas and the significant dislocation regularly exceeding the complete width of the odontoid (Fig. 1a, b). In addition, it is characterised by CT-confirmed unilateral-or bilateral jumped (Fig. 1c, d) and sometimes even locked lateral

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

“…Surgical treatment of odontoid luxation fracture remains controversial. Our review of published reports revealed that different authors performed different surgical procedures for type II odontoid fractures associated with posterolateral atlas complete dislocation. In our case, after closed reduction had failed we operated via a posterior approach.…”

“…A search of published reports revealed that type II odontoid fracture combined with atlas posterolateral dislocation is rare, only nine cases with adequate radiography data having been reported thus far; reduction with cervical traction was achieved in only three of eight cases (Table ). Many factors can make reduction of this type of injury difficult, the central factor likely being bilateral interlocking of the atlantoaxial lateral mass joint.…”

“…Odontoid fracture‐dislocation, a highly unstable traumatic lesion of the atlantoaxial complex, is most often associated with an Anderson type II odontoid fracture. However, sometimes patients with this injury have no or mild neurological deficits because of interlocking of the articular processes, which prevents the atlas from rocking and therefore prevents further spinal injury.…”

“…Type II odontoid fracture associated with atlas posterolateral dislocation is a rare upper cervical injury, only such nine cases having been reported so far in English. Because so few case reports have been published, no consensus has been reached regarding the extent of the damage and treatment of this type of injury. Reduction was achieved by traction in only three of nine previously reported cases.…”