J Korean Soc Spine Surg.  2005 Jun;12(2):153-157. 10.4184/jkss.2005.12.2.153.

Distractive Atlantoaixial Dislocation

• Park HJ
• Oh JR
• Lee PE

• KMID: 1583460
• DOI: http://doi.org/10.4184/jkss.2005.12.2.153

Abstract

Atlantoaxial dislocations usually present with fatal brain injury, but rarely with clinical problems. With the development of newer imaging techniques, as well as improved preoperative and perioperative care, the likelihood of survival from an atlantoaxial dislocation has increased. Survivors usually suffer incomplete neurological deficits, including Brown-Sequard syndrome or central cord syndrome. The authors describe a distractive atlantoaxial dislocation, with neurological sequelae, in a younger patient who had been involved in a car accident. This case was treated surgically, but the patient suffered paraplegia due to thoracic myelopathy.

Keyword

Cervical spine; Atlantoaxial dislocation; Arthrodesis

MeSH Terms

Arthrodesis
Brain Injuries
Brown-Sequard Syndrome
Central Cord Syndrome
Dislocations*
Humans
Paraplegia
Perioperative Care
Spinal Cord Diseases
Survivors

Figure

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  Fig. 1. (A)Initial lateral plain radiograph shows isolated C1-C2 dislocation with 11 mm of vertical C1-C2 gap and 10 mm of ADI. (B) Open mouth view.

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  Fig. 2. Noncontrast T1 and T2-weighted sagittal magnetic res-onace imaging of cervical spine shows vertical migration and anterior displacement of atlas.

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  Fig. 3. Postoperative one year roentgenogram showing solid arthrodesis between C1-C2.

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  Fig. 4. Noncontrast T1 and T2-weighted sagittal scan demonstrates the atrophy of spinal cord and epidural fat at T10-T11 level.

Reference

1). Jonsson H Jr, Bring G, Rauschning W, Sahlstedt B. Hidden cervical spine injuries in traffic accident victims with skull fractures. J Spinal Disord. 1991; 4:251–263.

2). Matava MJ, Whitesides TE Jr, Davis PC. Tr aum ati c atlanto-occipital dislocation with survival. Spine. 1993; 18:1897–1903.

3). Dickman CA, Papadopoulos SM, Sonntag VK, Spetzler RF, Rekate HL, Drabier J. Tramatic occipitoatlantal dislocations. J Spinal Disord. 1993; 6:300–313.

4). DiBenedetto T, Lee CK. Traumatic atlanto-occiptital instability: a case report with follow-up and a new diagnostic technique. Spine. 1990; 15:595–597.

5). Eismont FJ, Bohlman HH. Posterior atlanto-occipital dislocation with fractures of the atlas and odontoid process. J Bone Joint Surg Am. 1978; 60:397–399.

6). Montane I, Eismont FJ, Green BA. Traumatic occipitoatlantal dislocation. Spine. 1991; 16:112–116.

7). Page CP, Story JL, Wissinger JP, Branch CL. Traumatic atlanto-occipital dislocation: case report. J Neurosurg. 1973; 39:394–397.

8). Traynelis VC, Marano GD, Dunker RO, Kaufman HH. Traumatic atlanto-occipital dislocation: case report. J Neurosurg. 1986; 65:863–870.

9). Bucholz RW, Burkhead WZ. The pathological anatomy of fatal atlanto-occipital dislocations. J Bone Joint Surg Am. 1979; 61:248–250.

10). Dublin AB, Marks WM, Weinetock D, Newton TH. Traumatic dislocation of the atlanto-occipital articulation (AOA) with short term survival. J Neuro surg. 1980; 52:541–546.

11). Levine AM, Edwards CC. Treatment of injuries in C1-C2 complex. Orthop Clin North Am. 1986; 17:31–44.

12). Ramare S, Lazennec JY, Camelot C, Saillant G, Hansen S, Trabelsi R. Vertical atlantoaxial dislocation. J Eur Spine. 1999; 8:241–243.