Posterior atlantoaxial dislocation without fracture or neurological symptoms treated by transoral-posterior approach surgery: a case report and literature review

Abstract

Background: Atlantoaxial dislocation usually results from hyperextension trauma and is almost always accompanied by odontoid fracture and neurological symptoms. In most cases, patients with atlantoaxial dislocation die instantly. This is a rare report of posterior atlantoaxial dislocation without fracture and neurological symptoms effectively treated by transoral-posterior approach surgery, and only eleven similar cases have been previously reported.

Objective: To describe the very rare case of an adult posterior atlantoaxial dislocation patient without fracture who was neurologically treated using transoral-posterior approach surgery and to review the relevant literature.

Method: A 52-year-old man riding a motorcycle was rear-ended by a car. Using X-ray, computed tomography (CT) scan and magnetic resonance imaging (MRI), he was diagnosed with posterior atlantoaxial dislocation without a related fracture or a significant change in spinal cord signal. Transoral-posterior approach surgery with sustained skull traction was used after failed closed reduction.

Result: During a 6-month follow-up observation, the lateral cervical spine radiography and sagittal reconstructions of CT scans demonstrated no instability of the atlantoaxial complex. Few patients experience posterior atlantoaxial dislocation without a related fracture or spinal cord deficit. For a patient who experiences trauma with hyperextension, such as in rear-end collisions, X-ray, CT scan and MRI should be performed to ensure that this injury is diagnosed. It is necessary to perform surgery to recover atlantoaxial stability, even in the absence of fracture or neurological symptoms.

Conclusion: Transoral-posterior approach surgery is a safe and effective way to manage irreducible posterior atlantoaxial dislocation.

Keywords: Atlantoaxial dislocation; Skull traction; Transoral–posterior.