Traumatic Posterior Atlantoaxial Dislocation without Related Fractures of C1 - C2 in a Patient with Traumatic Brain Injury: Case Report and Literature Review
International Journal of Neurosurgery
Volume 3, Issue 1, June 2019, Pages: 5-8
Received: Feb. 6, 2019;
Accepted: Jun. 25, 2019;
Published: Jul. 9, 2019
Views 274 Downloads 47
Lenin Moyo, Department of Surgery, Neurosurgery Unit, University of Zimbabwe, Harare, Zimbabwe
Aaron Musara, Department of Surgery, Neurosurgery Unit, University of Zimbabwe, Harare, Zimbabwe
Kazadi Kalangu, Department of Surgery, Neurosurgery Unit, University of Zimbabwe, Harare, Zimbabwe
It is exceptionally rare to have posterior atlanto axial dislocation without an associated atlas or odontoid fracture and very few cases have been reported in literature. We present a case of a 50 year old female pedestrian who was hit by car while crossing a road. She presented with a depressed level of consciousness and the Glasgow coma score of 12/15, pupils were equal and reactive to light and all limbs were moving equally. She had an extensive abrasion on the forehead which extended into scalp. CT scan showed a posterior dislocation of the atlas with respect of axis with no associated fractures of C 1 and C2. She had traumatic subarachnoid hemorrhage in the basal cisterns and multiple brainstem contusions. Closed reduction of the dislocation was done successfully under fluoroscopy guidance. MRI was done post reduction because funds were not available initially and it showed increased signal in the tectorial membrane and transverse and alar ligaments with mild cord oedema at the cervicomedullary junction. However, the patient post reduction began to deteriorate and eventually passed away before definitive treatment of her cervical-spine injury. The case is reported in view of its rarity and to review literature on this uncommon condition.
Traumatic Posterior Atlantoaxial Dislocation without Related Fractures of C1 - C2 in a Patient with Traumatic Brain Injury: Case Report and Literature Review, International Journal of Neurosurgery.
Vol. 3, No. 1,
2019, pp. 5-8.
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Xu Y, Li F, Guan H, Xiong W. Traumatic Posterior Atlantoaxial Dislocation Without Associated Fracture but With Neurological Deficit. Medicine (Baltimore) [Internet]. 2015 Oct 30 [cited 2019 Jun 18]; 94 (43). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985386/
Lopez AJ, Scheer JK, Leibl KE, Smith ZA, Dlouhy BJ, Dahdaleh NS. Anatomy and biomechanics of the craniovertebral junction. Neurosurg Focus. 2015 Apr; 38 (4): E2.
Salunke P. Congenital Atlantoaxial Dislocation: Nature’s Engineering Gone Wrong and Surgeon’s Attempt to Rectify It. J Pediatr Neurosci. 2018; 13 (1): 1–7.
Hu D, Yang X, Wang J. Traumatic Posterior Atlantoaxial Dislocation Without Fracture of Odontoid Process: A Case Report and Systematic Analysis of 19 Cases. J Orthop Trauma. 2015 Sep; 29 (9): e342-345.
Deepak AN, Salunke P, Sahoo SK, Prasad PK, Khandelwal NK. Revisiting the differences between irreducible and reducible atlantoaxial dislocation in the era of direct posterior approach and C1-2 joint manipulation. J Neurosurg Spine. 2017 Mar; 26 (3): 331–40.
Yin Q, Wang J. Current Trends in Management of Atlantoaxial Dislocation. Orthop Surg. 2015 Aug; 7 (3): 189–99.
Meyer C, Eysel P, Stein G. Traumatic Atlantoaxial and Fracture-Related Dislocation [Internet]. BioMed Research International. 2019 [cited 2019 Jun 18]. Available from: https://www.hindawi.com/journals/bmri/2019/5297950/
Yu HM, Malhotra K, Butler JS, Wu SQ. Anterior and posterior fixation for delayed treatment of posterior atlantoaxial dislocation without fracture. BMJ Case Rep. 2015 Oct 29; 2015.
Lacy J, Gillis CC. Atlantoaxial Instability. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 [cited 2019 Jun 18]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK519563/
Offiah CE, Day E. The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. Insights Imaging. 2017 Feb; 8 (1): 29–47.
Huang D-G, Hao D-J, He B-R, Wu Q-N, Liu T-J, Wang X-D, et al. Posterior atlantoaxial fixation: a review of all techniques. Spine J Off J North Am Spine Soc. 2015 Oct 1; 15 (10): 2271–81.
Kukreja S, Ambekar S, Sin AH, Nanda A. Occipitocervical Fusion Surgery: Review of Operative Techniques and Results. J Neurol Surg Part B Skull Base. 2015 Sep; 76 (5): 331–9.
Polli FM, Miscusi M, Forcato S, Raco A. Atlantoaxial anterior transarticular screw fixation: a case series and reappraisal of the technique. Spine J Off J North Am Spine Soc. 2015 Jan 1; 15 (1): 185–93.
Du JY, Aichmair A, Kueper J, Wright T, Lebl DR. Biomechanical analysis of screw constructs for atlantoaxial fixation in cadavers: a systematic review and meta-analysis. J Neurosurg Spine. 2015 Feb; 22 (2): 151–61.
Chun DH, Yoon DH, Kim KN, Yi S, Shin DA, Ha Y. Biomechanical Comparison of Four Different Atlantoaxial Posterior Fixation Constructs in Adults: A Finite Element Study. Spine. 2018 01; 43 (15): E891–7.