Surgical Management for Posterior Atlantoaxial Dislocation without Fracture and Atlantoaxial Dynamic Test to Confirm the Integrity of the Transverse Ligament: A Case Report

Abstract

Background: Traumatic posterior atlantoaxial dislocation (PAAD) without fracture of the odontoid process is a rare injury. Closed reduction by skull traction under C-arm fluoroscopic guidance and open reduction have been reported previously for the treatment of PAAD.Objective: To report a rare case of PAAD without fracture treated by closed manual reduction and posterior fixation.To provide a new method-atlantoaxial dynamic test-for confirming the integrity of the transverse ligament after reduction and evaluate the ideal treatment strategy for traumatic PAAD without fracture of the odontoid process or rupture of the transverse ligament.Method: A 54-year-old woman was riding in the passenger seat when her vehicle was rear-ended by a car. X-ray and computed tomography (CT) scans were used to diagnose PAAD without a related fracture. Closed manual reduction under C-arm fluoroscopy was performed after applying general anesthesia via sober intubation, and the integrity of the transverse ligament was confirmed by the atlantoaxial dynamic test with C-arm fluoroscopy. Then, pedicle screw internal fixation via the posterior approach was applied to maintain atlantoaxial stability. Results:The procedure was performed uneventfully, and the patient was able to move out of bed on the first day after surgery with Philadelphia cervical gear. During a 2-year follow-up period, imaging data demonstrated no instability of the atlantoaxial complex. Conclusion:Closed manual reduction under C-arm fluoroscopy is an easy and effective method for PAAD. The integrity of the transverse ligament can be confirmed by C-arm fluoroscopy through the atlantoaxial dynamic test after reduction. Pedicle screw internal fixation via the posterior approach can provide sufficient stability.

Early Outcomes of Bone Autografting in the Bilateral Atlantoaxial Joints Applied in Posterior Fusion Surgery

“…Therefore, decompressing the neurological structures, realignment of the cervical spine, and stabilizing the unstable atlantoaxial complex are necessary for patients suffering from atlantoaxial dislocation or instability. [4][5][6] Posterior surgical procedures have been considered effective treatment strategies for atlantoaxial dislocation or instability, and the fusion rates ranged from 89%-100%. [7][8][9] The bone graft is usually placed across C1-C2 for fusion in these procedures.…”

“…Given the particular anatomical location, such dysfunction could threaten the brain stem and upper spinal cord. Therefore, decompressing the neurological structures, realignment of the cervical spine, and stabilizing the unstable atlantoaxial complex are necessary for patients suffering from atlantoaxial dislocation or instability 4–6 …”

“…Therefore, decompressing the neurological structures, realignment of the cervical spine, and stabilizing the unstable atlantoaxial complex are necessary for patients suffering from atlantoaxial dislocation or instability. 4 , 5 , 6 …”

Using additive manufacturing for craniocervical reconstruction in traditionally challenging cases

“…For example, primary benign invasive and malignant tumors of spine require en bloc resection to achieve local control and long-term survival [1]. In addition, atlantoaxial dislocation (AAD) requires full release to reduction, which often disrupts the original stability [2]. Therefore, reconstructing stability of upper cervical spine becomes an indispensable step of those surgeries.…”