Traumatic postero-lateral C1-C2 dislocation complicated with locked lateral mass and type II odontoid fracture - a 5-year follow-up: A case report.

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Traumatic postero-lateral C1-C2 dislocation complicated with locked lateral mass and type II odontoid fracture - a 5-year follow-up: A case report.

World Neurosurg. 2018 Apr 04;:

Authors: Minyu Z, Shiyang W, Suraj C, Kelun H, Chaowei L, Honglin T

Abstract
STUDY DESIGN: case report: Objective: To document our experience in managing a rare complex of traumatic postero-lateral atlantoaxial dislocation combined with locked lateral mass and type II odontoid fracture.
SUMMARY OF BACKGROUND DATA: METHOD: A 30 years-old male patient was referred to the author's department. He complained of a decrease in neck range of motion following a traffic accident. Neurological examination was normal. Computed tomography (CT) and open mouth X-ray showed a type II odontoid fracture and a postero-lateral dislocation with laterally locked left lateral mass at the C1-C2 level. Considering the difficulty and risk in reduction, due to this rare instability and dislocation, a two-staged treatment was performed. With up to 11 kg skull traction for 7 days before surgery, the locked lateral mass and the lateral dislocation was finally reduced without any neurological deficit. And once closed reduction was confirmed by open-mouth and lateral X-ray views in the cervical spine, a second staged C1-C2 surgical fixation and fusion with iliac bone graft was performed to achieve a normal anatomic alignment with a better stability.
RESULT: The patient showed significant amelioration of neck symptoms post-operatively and a successful reduction and fixation of the C1-C2 articulation was achieved. At the 5-year follow up, solid bone fusion was evident on the CT-scan.
CONCLUSION: For traumatic posterolateral atlantoaxial dislocation complicated with type II odontoid fracture, a closed reduction of the lateral dislocation before operation is both useful and safe because the surgeons do not need to reduce the extremely rare lateral dislocation during the operation. Posterior atlantoaxial stabilization and fusion, rather than the occipitocervical fusion as reported previously, is biomechanically stable enough to achieve solid fusion in this rare trauma while not sacrificing the occipito-atlantal joint.

PMID: 29626690 [PubMed - as supplied by publisher]

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