J Korean Soc Spine Surg.  2006 Jun;13(2):120-125. 10.4184/jkss.2006.13.2.120.

Delayed Rupture of the Transverse Atlantal Ligament Complicated after the Treatment of Posterior Neck Abscess: A case report

• Kim JH
• Kim SS
• Choi YS

• KMID: 2097828
• DOI: http://doi.org/10.4184/jkss.2006.13.2.120

Abstract

Atlantoaxial instability with rupture of transverse atlantal ligament is mostly caused by trauma, and this can be combined with myelopathy. Although it gives rise to no neurologic deficit, it has a high possibility to quadriplegia or death by minor trauma. We experienced a rare case about atlantoaxial instability with delayed rupture of transverse atlantal ligament that was complicated after the treatment of posterior neck abscess. A 44-year-old male patient had complained of posterior neck pain for 1 month. Based on a clinical examination, simple radiography, CT and MRI, his diagnosis was posterior neck abscess. He underwent an emergency operation with open drainage. One year later, he again had posterior neck pain. Atlantoaxial instability with rupture of the transverse atlantal ligament was confirmed. Skeletal traction was applied and then C1-2 posterior fusion without wiring was performed. After the operation, antibiotics were injected for 4 weeks and a halo-vest was put on for 6 months. Complete fusion of C1-2 was obtained without posterior neck pain at the 1 year follow-up.

Keyword

Delayed rupture of transverse atlantal ligament; Atlantoaxial instability; Posterior neck abscess

MeSH Terms

Abscess*
Adult
Anti-Bacterial Agents
Diagnosis
Drainage
Emergencies
Follow-Up Studies
Humans
Ligaments*
Magnetic Resonance Imaging
Male
Neck Pain
Neck*
Neurologic Manifestations
Quadriplegia
Radiography
Rupture*
Spinal Cord Diseases
Traction
Anti-Bacterial Agents

Figure

• 

  Fig. 1. Initial CT scan of the neck shows paraspinal abscess (arrows).

• 

  Fig. 2. Initial MRI (enhanced axial T1 weighted) shows paraspinal abscess around C1-2 level (arrows). Transverse atlantal ligament and C1-2 vertebrae are intact. There is no abscess in spinal canal.

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  Fig. 3. Lateral radiograph of neck taken at 3 months after open drainage shows normal bony structure.

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  Fig. 4. Preoperative lateral flextion radiograph of neck shows widening of the atlantoaxial interval and destruction of posterior arch of atlas (atlanto-dens interval 10 mm).

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  Fig. 5. Neck MRI A. The enhanced axial T1 weighted image shows rupture of transverse atlantal ligament and widening of distance between anterior arch of atlas and dens. B. The sagittal T2 weighted image shows low signal intensity in anterior arch of atlas and dens.

• 

  Fig. 6. This lateral radiograph of neck is taken at 1 year after C1-2 posterior arthrodesis. Posterior solid fusion in C1-2 is obtained.

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