The patient was informed that data concerning the case would be submitted for publication.Ī 48-year-old male patient, who was struck by an automobile on 6 December 2006, was transferred from a local county clinic to our university hospital 1 day after the traffic accident. In addition to the excellent visualization of this rare trauma entity via magnetic resonance imaging (MRI), computed tomography (CT) with multiplanar reconstruction (MPR) and three-dimensional reconstruction, the management of open reduction with partial excision of the odontoid process, atlantoaxial transarticular screw fixation and bony fusion through an anterior retropharyngeal approach also differs this case from the others. We present here the eleventh case of a posterior atlantoaxial dislocation without odontoid fracture or neurological deficit. All the ten cases had no or mild neurological deficit, most of the dislocations were conservatively reduced with traction, and some of them were supplemented with internal fixation and fusion through posterior approach. Transarticular screw fixation of the atlantoaxial articulation through anterior retropharyngeal approach is safe and useful in case the management of dislocation is unsuccessful under closed reduction.Īlthough postmortem radiology of head and neck injuries in fatal traffic accidents detected quite a high percentage of atlantoaxial dislocations, either with or without odontoid fracture, only ten cases of traumatic posterior atlantoaxial dislocation without odontoid fracture in which the patients had been survived were reported in the English literature. Routine CT and MRI of the cervical spine should be carried out in patients with head or neck trauma to prevent missing of this rare clinical entity. In conclusion, patients with posterior atlantoaxial dislocation without fracture may survive with few or no-long term neurological deficit. At the latest follow-up, the lateral cervical spine radiography in flexion and extension demonstrated no instability of the atlantoaxial complex 21 months after the operation. Transarticular screw fixation of the atlantoaxial articulation through anterior retropharyngeal approach was performed after several unsuccessful attempts of closed reduction. No related fracture of the odontoid process or neurological deficit was found in this patient. Posterior atlantoaxial dislocation was confirmed in a 48-year-old male struck by an automobile through conventional radiography, computed tomography and magnetic resonance imaging. The patient’s medical and radiographic history is reviewed as well as the relevant medical literature. The objective of this paper was to describe a case of traumatic posterior atlantoaxial dislocation without related fracture of the odontoid process, and its management with atlantoaxial transarticular screw fixation and bony fusion through an anterior retropharyngeal approach, and to review the relevant literature.
Traumatic posterior atlantoaxial dislocation without related fracture of the odontoid process is very rare, and only ten cases have been previously reported.
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