Acute traumatic lateral atlantoaxial dislocation associated with locked atlas lateral mass and odontoid process fracture: A clinical case study and literature review.
Lateral atlantoaxial dislocation
Lateral mass fracture
Odontoid process fracture
Journal
North American Spine Society journal
ISSN: 2666-5484
Titre abrégé: N Am Spine Soc J
Pays: United States
ID NLM: 9918335076906676
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
received:
16
08
2022
revised:
07
09
2022
accepted:
08
09
2022
entrez:
3
10
2022
pubmed:
4
10
2022
medline:
4
10
2022
Statut:
epublish
Résumé
Traumatic atlantoaxial dislocation combined with locked atlas lateral mass and odontoid process fracture is a complex injury and is extremely rare. We describe the surgical technique by presenting a clinical case study in managing a traumatic lateral atlantoaxial dislocation combined with a locked atlas lateral mass and a type II odontoid fracture (Grauer type IIB). This is a clinical case study of a 38-year-old female patient who presented with severe neck pain without neurological deficit following a traffic accident. Computed tomography showed a type IIB odontoid fracture and a lateral C1-C2 dislocation with a laterally locked left lateral mass at the C1-C2 level. Emergency management included protecting the cervical spine and applying gradually increasing skull traction. The locked lateral mass and laterally-dislocated C1-C2 facet joints were partially reduced. An intraoperative joint reduction operation with leverage technique was then performed. Posterior C1-C2 fixation (a modified Harms-Goel technique) and fusion with iliac bone graft were then executed. Postoperatively, neck pain improved significantly. The atlantoaxial joint was successfully reduced and stabilized. Solid bony fusion was confirmed by a radiographic study at the 1-year follow-up. Based on a review of current literature, traumatic lateral atlantoaxial dislocation combined with a locked atlas lateral mass and type IIB odontoid fracture is rarely seen. It is an extremely unstable injury. Our proposed leverage technique used in conjunction with a modified Harms-Goel technique is an effective alternative treatment. This approach can assist surgeons in the management of these difficult cases.
Sections du résumé
Background
UNASSIGNED
Traumatic atlantoaxial dislocation combined with locked atlas lateral mass and odontoid process fracture is a complex injury and is extremely rare. We describe the surgical technique by presenting a clinical case study in managing a traumatic lateral atlantoaxial dislocation combined with a locked atlas lateral mass and a type II odontoid fracture (Grauer type IIB).
Case description
UNASSIGNED
This is a clinical case study of a 38-year-old female patient who presented with severe neck pain without neurological deficit following a traffic accident. Computed tomography showed a type IIB odontoid fracture and a lateral C1-C2 dislocation with a laterally locked left lateral mass at the C1-C2 level. Emergency management included protecting the cervical spine and applying gradually increasing skull traction. The locked lateral mass and laterally-dislocated C1-C2 facet joints were partially reduced. An intraoperative joint reduction operation with leverage technique was then performed. Posterior C1-C2 fixation (a modified Harms-Goel technique) and fusion with iliac bone graft were then executed.
Outcome
UNASSIGNED
Postoperatively, neck pain improved significantly. The atlantoaxial joint was successfully reduced and stabilized. Solid bony fusion was confirmed by a radiographic study at the 1-year follow-up.
Conclusions
UNASSIGNED
Based on a review of current literature, traumatic lateral atlantoaxial dislocation combined with a locked atlas lateral mass and type IIB odontoid fracture is rarely seen. It is an extremely unstable injury. Our proposed leverage technique used in conjunction with a modified Harms-Goel technique is an effective alternative treatment. This approach can assist surgeons in the management of these difficult cases.
Identifiants
pubmed: 36185341
doi: 10.1016/j.xnsj.2022.100169
pii: S2666-5484(22)00072-5
pmc: PMC9520267
doi:
Types de publication
Case Reports
Langues
eng
Pagination
100169Informations de copyright
© 2022 The Author(s). Published by Elsevier Ltd on behalf of North American Spine Society.
Déclaration de conflit d'intérêts
All authors declare no conflict of interest.
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