Longitudinal atlantoaxial dislocation associated with type III odontoid fracture due to high-energy trauma. Case report and literature review

Abstract

Introduction Traumatic upper cervical spine injuries are frequently associated with high-energy trauma. The potential injuries to vital organs associated to a possible neurological damage marks the severity of this pathology. The neurological structures can be affected by a primary injury, spinal cord, cranial nerves and spinal nerves; or secondary to a vascular compromise, mainly the vertebral arteries. The dislocation of the atlantoaxial joint causes an unstable cervical spine that could be often associated with fracture of the Atlas and Axis. Evidently, these have a high morbimortality rate. Case presentation A young woman who suffered a severe polytrauma secondary to a motor vehicle collision was diagnosed with a sagittal plane atlantoaxial joint dislocation associated with a type III odontoid fracture, despite an adequate initial polytrauma management, the neurological damage was too critical, ultimately the decease of the patient. Discussion The atlantoaxial joint dislocation is a rare condition of the upper cervical spine and is usually secondary to a high-energy traumatism. The disruption of the atlantoaxial ligaments originates the considered most unstable cervical spine lesion and with the highest mortality. Attributable to the kinetic the bone fracture of the Atlas and Axis are commonly related, specially the odontoid process. Early immobilization followed by surgical decompression and stabilization is primordial. Typically, these injuries have an ominous prognosis, that is aggravated if added a polytrauma affecting adjacent neurological structures and other vital organs.

Developmental and surgical anatomy of pathologies of the craniovertebral junction: a much-needed problematization of efficacy and long-term outcomes

“…Their etiology is probably an outcome of many factors including a genetic base possible in the development of CM or syringomyelia (Boyles et al, 2006;Busis & Hochberg, 1985). High-impact trauma, on the other hand, may contribute to the increase of syringomyelia or atlantoaxial dislocations (Wichmann et al, 2020;Fischbein et al, 1999;Sánchez-Ortega et al, 2021). The occurrence of one pathology in this area does not exclude others.…”

“…Atlantoaxial disloca-tions are a frequent outcome of high-energy trauma with a high mortality rate. Odontoid fracturing often occurs in such situations (Sánchez-Ortega et al, 2021). Other risk factors include rheumatoid arthritis, tuberculosis, Hirayama disease, or myelopathy which is related to the ossification of the posterior longitudinal ligament (Goel, 2021).…”

“…Prevalent procedures are C1-C2 posterior fixations executed by transarticular Magerl or the above-mentioned Goel technique. New solutions include transpendicular axis mass fixation and an anterior transarticular fixation with the Vaccaro method (Sánchez-Ortega et al, 2021).…”

Advanced strategies for constructing interfacial tissues of bone and tendon/ligament

“…191 Since the enthesis and nerve injuries in the spine region often occur simultaneously, this scaffold could be more curative in the applications of spinal injuries. 192,193 In addition to the electrospun and salt-leached silk enthesis scaffolds, freeze-dried silk enthesis scaffold is another potential silk scaffold in enthesis TE. The overall fabricating process resembles that of the freeze-dried collagen scaffold, and a spongy-like porous silk scaffold can also be generated, which contains a splendid ECMbiomimetic inner architecture.…”

“… 191 Since the enthesis and nerve injuries in the spine region often occur simultaneously, this scaffold could be more curative in the applications of spinal injuries. 192 , 193…”