J Korean Neurosurg Soc.  1980 Mar;9(1):305-310.

Atlantal Fracture and Dislocation with Transverse Ligament Rupture Associated with Quadriplegia

• Lee SB
• Lee SS
• Sohn HC
• Moon MS

Abstract

Since Jafferson has reported the atlantal fracture in 1920, and its mechanism and type of fracture in detail, a few authers have reported the cases in their literature because the atlantal fractures are one of rare case in cervical injuries. The clinical signs are sparse indeed after acute transection or contusion of medulla. One survived has had a minimal neurologic deficit on account of wide vertebral canal for the cervical cord. The patient has complained the occipital headache and limited motion of neck commonly, without any neurological disturbance. The cervical tracton has been applied for the case usually. Recently, we experienced a case of atlantal fracture with occipito-atlantal dislocation and atlanto-axial dislocation, associated-with quadriplegia for 2.5 years progressively after cervical injury. On simple films of lateral view of cervical spine, it revealed a separated posterior arch was anteriorly dislocated and impacted into the vertebral canal, and anterior arch was markedly displaced anteriorly and had a bony union with the axis in angulated form. The odontoid process of axis is upward translocation. No fracture was found in open mouth view for the axis. The occipito-atlantal and atlanto-axial dislocation were found. On myelogram, the contrast media was almost obliterated in the false occipito-axial joint level by the compression of the fragmented posterior arch of atlas. On vertebral angiogram, it revealed a reverse curve of 3rd. portion of vertebral artery, representing the anterior arch of atlas included the arch retracted the vertebral artery anteriorly. We performed the suboccipital craniectomy and lanimectomy on the atlas for removal of posterior arch of atlas without any spine fusion, Because of the dislocated atlanto-axial joint had a bony union alreadly. The post-operative recovery was very rapid and satisfactory.

MeSH Terms

Atlanto-Axial Joint
Axis, Cervical Vertebra
Contrast Media
Contusions
Dislocations*
Headache
Humans
Joints
Ligaments*
Mouth
Neck
Neurologic Manifestations
Odontoid Process
Quadriplegia*
Rupture*
Spine
Vertebral Artery
Contrast Media