Combined traumatic atlantooccipital and atlantoaxial articulation instability: a case report with survival

Traumatic atlantooccipital dislocation is a rare injury in survivors with 15 % share in deaths due to spinal injury. The authors present a case of a patient with concurrent atlantooccipital and atlantoaxial instability of the upper cervical spine, which he suffered after a fall from height. Atlantooccipital dislocation in surviving patients is a rare injury, for which in some cases coincident bone injury is reported to upper cervical spine, such as occipital fracture or contingent odontoid (C2 dens) fracture. In our case, it is combined with atlantoaxial instability and this combined type of injury has not yet been described in the literature. We performed realignment of the dislocation and posterior occipitocervical (C0-C3) fusion. After the surgery, the patient manifested neurological improvement almost to a normal neurological outcome with persistent residual finding after subarachnoid hemorrhage.