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Traumatic atlantoaxial rotatory dislocation with odontoid fracture: case report and review
S Fuentes1, P Bouillot, O Palombi
1Department of Neurosurgery, La Timone University Hospital Center, Marseille, France. sfuentes@ap-hm.fr
Study Design:
A case of traumatic rotatory dislocation associated with odontoid fracture is reported.
Objectives:
To report a rare case of traumatic rotatory dislocation associated with odontoid fracture, and to discuss the mechanism underlying spinal instability and management.
Summary Of Background Data:
This case is a cross between traumatic rotatory fixation and atlantoaxial rotatory dislocation. Classification of rotatory subluxation change after osteosynthesis of the odontoid process was undertaken.
Methods:
A 24-year-old man sustained head and cervical injury after jumping. A Type 2 odontoid fracture without displacement was noted.
Results:
Without further traumatic event, 1 month after injury, computed tomography scan showed posterior displacement of the odontoid fracture and Type 4 or B atlantoaxial rotatory luxation. After surgical fixation and reduction of the odontoid fracture, the rotatory subluxation classification changed and became Type 1 or A. Posterior C1-C2 arthrodesis was performed. The patient wore a Philadelphia cervical collar for 3 months and underwent physiotherapy.
Conclusions:
As the pivot of rotatory subluxation changed after odontoid process osteosynthesis, posterior C1-C2 arthrodesis was performed. The patient probably could have been treated in a single-stage procedure using posterior C1-C2 transarticular fixation with bicortical interspinous graft.