Published online Feb 26, 2021. doi: 10.12998/wjcc.v9.i6.1461
Peer-review started: October 31, 2020
First decision: December 8, 2020
Revised: December 21, 2020
Accepted: December 30, 2020
Article in press: December 30, 2020
Published online: February 26, 2021
In general, atlantoaxial dislocation is rare due to the stability of the C1-C2 complex. Traumatic atlantoaxial dislocations are usually anterior and accompanied by odontoid fractures. Posterior atlantoaxial dislocations are rare, and complete posterior dislocation without associated fracture is even more rare. A case of early recurrence of posterior atlantoaxial dislocation without fracture being in therapy of first closed reduction and then open reduction has not been previously reported.
A 45-year-old female presented with traumatic posterior atlantoaxial dislocation (TPAD) of C1-C2 without associated fractures, and Frankel Grade B spinal cord function. She was successfully managed by immediate closed reduction under skull traction. Unexpectedly, 17 d later, re-dislocation was discovered. On day 28, closed reduction was performed as before but failed. Then, open reduction and posterior internal fixation with autologous iliac bone grafts was performed. By 6 mo after surgery, atlantoaxial joint fusion was achieved, and neurological function had recovered to Frankel Grade E. At 12 mo follow-up, she had lost only 15° of cervical rotation, and atlantoaxial complex instability in joint flexing and extending were no longer observed under fluoroscopy.
Early assessment of transverse ligament is critical for TPAD without fracture avoiding re-dislocation after closed reduction.
Core Tip: Traumatic posterior atlantoaxial dislocations (TPADs) without fracture are rare. In this article, we present a 45-year-old female with early recurrence of TPAD of C1-C2 without associated fractures. The patient first underwent closed reduction and then open reduction, internal fixation, and interfacial fusion. Excellent results were achieved. In conclusion, early assessment of the condition of the transverse ligament is critical for the prevention and early discovery of the re-dislocation of TPADs.