Traumatic Posterior Atlantoaxial Dislocation With an Associated Fracture

Abstract

Study design: Systematic review. Objective: To investigate the clinical presentation, mechanism of injury, patients’ characteristics, diagnosis, treatment, and prognosis of traumatic posterior atlantoaxial dislocation with fracture (TPAD). Background: TPAD is an extremely rare entity, with a limited number of cases reported in the literature. Although rare, a thorough understanding of the pathogenesis and management of such cases is required due to the high risk of spinal cord compression and the severity of neurological deficits. We conducted a systematic review of all cases of TPAD with fractures reported in the literature. Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines. Relevant literature was retrieved from the Pubmed database. All published English-written studies involving human subjects with relevant data regarding TPAD were included. Results: Two case series and 20 case reports published between 1924 and 2021 describing 28 patients with TPAD were included. The median age at presentation was 51.5 years, with male predominance (83%). The most common fracture pattern was Anderson and D’alonzo type II odontoid fracture (78%). Neurological exam at presentation was intact in 52% of patients. The primary diagnostic imaging was computed tomography employed in 96% of cases. The management consisted of 2 stages protocol, initially, a temporary axial traction was employed (54%), and later definitive surgical treatment was employed (93%). The posterior surgical approach was favored in 82% of cases. Conclusion: TPAD with fracture occurred in the majority of cases with Anderson and D’alonzo type II odontoid fracture, predominantly in males. Diagnosis is usually established based on computed tomography imaging; further imaging may not be indicated as it does not seem to alternate the patient’s management course. Surgical intervention was employed in almost all cases, with favored results through posterior C1–C2 fusion. Level of evidence: Level—IV

Vertebral artery injury following combination Jefferson fracture of C1 and Type II odontoid fracture: A case report

“…Posterior instability occurs when the integrity of the bony support, either the odontoid process or the anterior arch of C1 is compromised by major trauma, leading to posterior displacement of C1 in relation to C2. 2 Regarding the treatment of atlantoaxial dislocation, there is a consensus that reduction has to be performed as soon as possible in all cases, to prevent residual instability and development of permanent deformity. Several authors reported that the reduction of the dislocation was achieved using traction but all cases were atlantoaxial dislocation with an isolated odontoid process fracture (without C1 fracture).…”

“…The odontoid process acts as a pivoting anchor in the C1–C2 configuration, which makes the trans‐odontoid luxation fracture a highly unstable traumatic lesion of the atlantoaxial complex. Posterior instability occurs when the integrity of the bony support, either the odontoid process or the anterior arch of C1 is compromised by major trauma, leading to posterior displacement of C1 in relation to C2 2 . Regarding the treatment of atlantoaxial dislocation, there is a consensus that reduction has to be performed as soon as possible in all cases, to prevent residual instability and development of permanent deformity.…”

“…Concomitant dislocation of the C1‐2 fracture and odontoid fracture is a rare entity. A recent systematic review has reported that Anderson and D'alonzo type II odontoid fracture causes 78% of traumatic posterior atlantoaxial dislocation (TPAD), which can result in spinal cord injury and further increase the fatal nature of this injury 1,2 . Additionally, fractures involving the upper cervical spine put patients at significant risk of vertebral artery injuries (VAIs) 3 .…”

“…A recent systematic review has reported that Anderson and D'alonzo type II odontoid fracture causes 78% of traumatic posterior atlantoaxial dislocation (TPAD), which can result in spinal cord injury and further increase the fatal nature of this injury. 1,2 Additionally, fractures involving the upper cervical spine put patients at significant risk of vertebral artery injuries (VAIs). 3 Although most of these injuries are clinically silent as the opposing vertebral artery (VA) and the Willis circle provide adequate collateral blood supply, some authors report significantly higher rates of cerebral infarction after an injury.…”