Treatment of dens fractures with posterior atlantoaxial dislocation with transoral atlantoaxial reduction plate surgery: case report and introduction of a novel treatment option

Abstract

Study design: Case report.

Objective: To describe a rare old dens fracture with posterior atlantoaxial dislocation that was treated with transoral atlantoaxial reduction plate surgery.

Summary of background data: Dens fractures with posterior atlantoaxial displacement are not common and cause ventral compression of the spinal cord. Management of this type of fracture is through skull traction and external fixation, posterior laminectomy and fusion, or transoral reduction and posterior fusion.

Methods: A 38-year-old man sustained a car accident and was diagnosed with type II dens fractures (the classification system of Anderson and D'Alonzo) and posterior atlantoaxial dislocation. The neurological function of the patient was C grade according to the standard neurological classification of spinal cord injury from the American Spinal Association. Because of multiple trauma involving the head, lung, and the abdomen, he was treated with skull traction with about 10° of flexion. No signs of reduction were observed. The patient was treated operatively 70 days after the injury. We performed a transoral atlantoaxial reduction plate surgery using a transoral approach for release, reduction, and fixation. Finally, anterior fusion with iliac bone graft was applied.

Results: Complete atlantoaxial reduction and decompression of the spinal cord were achieved. The patient felt better after surgery. Movement of his extremities raised from grade II-III force to grade IV-V, and neurological status improved from American Spinal Association grade C to D.

Conclusion: The treatment option achieved instant reduction, decompression, and fixation. A new treatment option for this type of injury is recommended.