Abstract
BACKGROUNDAtlantoaxial dislocation (AAD) is a rare and potentially life-threatening condition. Various underlying mechanisms of injury are described in the literature. Here, the authors report an unusual nontraumatic injury mechanism of AAD in a 12-year-old patient.OBSERVATIONSA 12-year-old boy presented with intolerable neck pain and numbness in both upper limbs. The patient’s symptoms had started 2 months after the initiation of online classes during the coronavirus disease 2019 pandemic without a history of trauma. He used a computer for personal study and online classes for prolonged hours with no respite. On physical and radiological evaluation, he was diagnosed with AAD. Before surgery, skull traction was applied to reduce the dislocation and posterior C1 lateral mass screw and C2 pedicle screw fixation was performed. An optimal clinical outcome was achieved with no postoperative complications. A preoperative visual analog scale score of 8.0 was reduced to 0 postoperatively.LESSONSA prolonged fixed neck posture is an unusual underlying cause of AAD. Posterior C1 lateral mass and C2 pedicle screw fixation results in an optimal clinical outcome.
Highlights
Atlantoaxial dislocation (AAD) is a rare and potentially life-threatening condition
Even though injuries and dysfunction of the atlantoaxial joints (AAJs) commonly occur, traumatic AAD is rare in the literature.[4]
Certain congenital anomalies and chromosomal inherited disorders such as Down syndrome have been reported to be prone to joint instability due to associated osseous and ligamentous abnormalities.[7]
Summary
Atlantoaxial dislocation (AAD) is a rare and potentially life-threatening condition. Various underlying mechanisms of injury are described in the literature. The authors report an unusual nontraumatic injury mechanism of AAD in a 12-year-old patient. Skull traction was applied to reduce the dislocation and posterior C1 lateral mass screw and C2 pedicle screw fixation was performed. Posterior C1 lateral mass and C2 pedicle screw fixation results in an optimal clinical outcome. The flexible articulation interaction of C1, the dens, and the transverse ligament is responsible for over 50% of all cervical spine rotation.[1,2] AAJ stability can be disrupted by trauma, congenital anomalies, and idiopathic and inflammatory processes.[2] Here, we report an unusual mechanism of injury leading to AAD in a 12-year-old patient
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