Meyer Type III Vertical Atlantoaxial Distraction with Complete Ligamentous Disruption: A Case Report and Surgical...

Vertical atlantoaxial distraction (AAD) represents a rare and severe form of craniocervical injury caused by high-energy trauma. It involves vertical separation of the atlas and axis due to complete rupture of the ligamentous stabilizers and poses an immediate risk of neurological or vascular compromise.

A 33-year-old male sustained multiple injuries following a suicidal jump from 10 m, including a Type III vertical AAD with 6 mm distraction between the C1 and C2 lateral masses. Imaging revealed complete rupture of the alar, apical, and posterior longitudinal ligaments, bilateral facet joint capsule disruption, and a Gehweiler Type I anterior arch fracture of C1. A traumatic dural tear with suspected cerebrospinal fluid (CSF) leak was also identified. Initial anterior stabilization was performed with mini-fragment screws, followed by delayed posterior C1/C2 fusion via transarticular screws 1 week later due to clinical instability. Intraoperative correction of a 10-degree C1-C2 rotational deformity was achieved, and dural repair was completed using TachoSil and muscle graft. The patient remained neurologically intact and had an uneventful recovery. Follow-up imaging at 1 year demonstrated stable alignment of the construct without signs of hardware loosening, failure, or new neurological findings. At the 6-year follow-up, the patient remained neurologically intact with preserved cervical rotation up to 50 degrees.

This case highlights the diagnostic complexity and management challenges associated with vertical AAD. A classification-based surgical strategy supported by high-resolution imaging and intraoperative navigation led to successful stabilization and excellent neurological outcome.