Lateral C1–C2 dislocation complicating a type II odontoid fracture

Lenehan, Brian; Guerin, Shane; Street, John; Poynton, A. R.

doi:10.1016/j.jocn.2009.11.025

Cited by 29 publications

(21 citation statements)

References 20 publications

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“…We identified several case reports and case series describing the occurrence and management of combined C1-C2 dislocation and fracture of the dens. 4,9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24] Corner described 2 of the earliest cases of rotatory dislocation of C1 relative to C2 with accompanying fractures of the odontoid process. 25…”

Section: Discussion Literature Reviewmentioning

confidence: 99%

“…3 After conducting a literature search of PubMed, Scopus, Google Scholar, and relevant reference lists, we found only 1 other published case of lateral C1 subluxation. 4 Therefore, the reported case of lateral subluxation of C1 relative to C2 is a rare injury. Traumatic atlantoaxial dislocation is an often lethal injury involving atlas-axis fractures, fracture of odontoid process, and/or other cervical spine fractures that result from high-velocity trauma.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussion Literature Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…Surgery is only required if closed reduction attempts have failed. 11,12 However, the treatment plan for neglected cases needs to be tailored according to several factors, including the patient's age, time lapse from initial injury, preexisting medical morbidity, severity of injury, stability of the C1 to C2 articulation, ease of reduction, and most importantly, the medical facility's capabilities, because these cases are frequently found in underdeveloped countries. 13 Fracture reduction in delayed cases is often impossible because several changes have occurred since the initiating injury: (1) the anterior tissues over the craniovertebral area became contracted and shortened, (2) the C1 to C2 kyphotic deformity caused contracture of the muscles of the neck (such as longus colli and longus capitis) along with contracture of the joint capsules and the anterior longitudinal ligaments, and (3) the C1 to C2 articular surfaces gradually became arthritic and bony bridges eventually formed around the dens and body of the axis, further impeding the reduction maneuver.…”

Section: Discussionmentioning

confidence: 99%

Occipitocervical Fusion and Posterior Fossa Decompression in Neglected Jefferson Fracture-Dislocation of Atlas Associated With Odontoid Peg Fracture: A Case Report

et al. 2019

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Background: Only a few cases of traumatic atlantoaxial fracture-dislocation have been reported, and neglected cases are seldom found because of the fatal nature of this condition. Methods: We reported a neglected case of Jefferson fracture-dislocation associated with type II displaced odontoid peg fracture which was nonambulatory and myelopathic. A surgical plan involving posterior fossa decompression and laminectomy of the posterior arch of atlas following posterior spinal instrumentation was then conducted. Results: Patient experienced marked neurologic recovery and was able to stand and walk with assistance during the early postoperative period. Conclusions: This procedure may be an effective alternative treatment in neglected cases.

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“…Granulation tissue, callus around the dens, scarring between the dens and axis, and locking of the atlantoaxial lateral joints are the major reasons for irreducibility of dislocation. 5 The reconstructed CT images of the CVJ give a fair idea about the cause of fixity apart from the extent of injury. The presence and extent of facet fractures are important factors in deciding the management.…”

Section: Discussionmentioning

confidence: 99%

“…However, rotational and lateral C1-2 dislocation is rare. 5,9 The C1-2 facets may get locked, making the dislocation irreducible. We describe a rare case of irreducible C1-2 posterior and true lateral dislocation that was managed successfully by a direct posterior approach.…”

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confidence: 99%

Direct posterior reduction in a case of posttraumatic irreducible lateral atlantoaxial dislocation

Salunke¹,

Sahoo²,

Doddamani³

et al. 2014

SPI

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T raumaTic atlantoaxial (C1-2) dislocation with Type II odontoid fracture is not uncommon. This usually occurs in the anteroposterior or sagittal plane. However, rotational and lateral C1-2 dislocation is rare. 5,9 The C1-2 facets may get locked, making the dislocation irreducible. We describe a rare case of irreducible C1-2 posterior and true lateral dislocation that was managed successfully by a direct posterior approach. The mode of injury and the method used to achieve intraoperative reduction are discussed. Case ReportHistory and Examination. This 34-year-old man sustained injury in a motor vehicle accident. His face got compressed against the left windowpane due to sudden deceleration, giving rise to distraction and lateral extension of the spine. After a brief period of blackout, he got up and walked around. Apart from mild neck pain he had no other complaints. He did not seek any medical help immediately following injury, because his only symptom of neck pain was not significant. However, 4 weeks later his neck pain worsened and he experienced restricted neck movements. Neurological examination revealed no deficits.A lateral radiograph of the cervical spine showed Type II odontoid fracture with posterior C1-2 dislocation. Admission CT scans of the craniovertebral junction (CVJ) showed true right lateral C1-2 dislocation and locked facets with odontoid fracture (Fig. 1). The fracture line at odontoid base and facets showed no malunion. Skull traction was applied but failed to reduce the dislocation. Besides, the patient's neck pain worsened with skull traction. Because the transverse foramina appeared intact and there were no congenital bone anomalies, we assumed that the vertebral arteries (VAs) were normal, with the redundant V 3 segment compensating for the lateral stretch. We were fortunate not to have any vascular complications. Nevertheless, a preoperative CT angiogram would have been preferable. Posttraumatic true irreducible C1-2 lateral dislocation is rare. The mechanism of injury is likely to be different for this kind of dislocation. The management of such an injury and the technique for direct posterior reduction remain unclear because of its rarity. The authors describe the case of a 34-year-old man who sustained injury in a vehicular accident, leading to neck pain. Radiological studies revealed fixed right lateral and posterior C1-2 dislocation. Direct posterior open reduction was achieved by distracting the facets and rotating them in a counterclockwise direction. Care was taken to avoid direct or indirect injury to the vertebral arteries. Segmental C1-2 fusion was performed. Distraction with lateral extension injury possibly gives rise to this unique fracture dislocation. Preoperative imaging including angiography for vertebral arteries helps in defining the cause of fixity and in surgical planning. Direct posterior reduction is possible in such fixed C1-2 lateral dislocation, circumventing transoral surgery-provided the facets are preserved.

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Lateral C1–C2 dislocation complicating a type II odontoid fracture

Cited by 29 publications

References 20 publications

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

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

Occipitocervical Fusion and Posterior Fossa Decompression in Neglected Jefferson Fracture-Dislocation of Atlas Associated With Odontoid Peg Fracture: A Case Report

Direct posterior reduction in a case of posttraumatic irreducible lateral atlantoaxial dislocation

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