Traumatic Atlantoaxial and Fracture-Related Dislocation.

Carolin Meyer,Peer Eysel,Gregor Stein

doi:10.1155/2019/5297950

Carolin Meyer, Peer Eysel + Show 1 more

Open Access

https://doi.org/10.1155/2019/5297950

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Abstract

Traumatic atlantoaxial dislocation due to ligamentous and combined osseous injuries rarely occurs in adults. There are only few cases published in the literature. In this level 4 study, a cohort of nine consecutive patients suffering from traumatic atlantoaxial dislocation has been analyzed regarding morphology of injury, trauma mechanism, and outcome since 2007. Three types of those injuries have been found regarding direction of dislocation indicating the underlying ligamentous injuries as well as the accompanying grade of instability. Firstly, there was rotatory dislocation, if the alar ligaments were injured. Secondly, there occurred horizontal dislocation, when transverse atlantal ligament was damaged additionally. Thirdly, excessive ligamentous injury led to distraction of the atlantoaxial complex resulting in dissociation of the atlas against the axis. Additionally fractures of the atlas as well as of the odontoid process (type II or III according to Anderson/D'Alonzo) were diagnosed frequently. Atlantoaxial dislocation injuries, especially distraction injuries, offer a high risk for accompanied neurovascular disorders deserving reduction followed by surgical fixation. Only rotatory injuries leading to ligamentous damage solitarily can safely be successfully treated conservatively. Understanding of the injuries' morphology is essential, in order to set the correct diagnosis and to implicate the most advantageous treatment regime.

Highlights

Traumatic atlantoaxial dislocation appears to be an infrequent entity in adults coming along with an outstanding threat to health
Trauma imaging and surgical documentation as well as follow-up imaging and electronic health records of nine consecutive patients suffering from atlantoaxial dislocation were analyzed
The alar ligaments were destroyed in every case as well as the capsule of the dislocated facet joint

Summary

Introduction

Traumatic atlantoaxial dislocation appears to be an infrequent entity in adults coming along with an outstanding threat to health. Due to the unique anatomy of the atlantoaxial complex, which provides high-level mobility, it protects and guides the vertebral arteries and the spinal cord Injuries of these cervical structures are often accompanied by neurovascular complications and can possibly lead to death. If there is a bilateral displacement around the center of the odontoid process the lesion this is typed E [8] Most frequently in these cases of rotatory or anterior-posterior dislocation, fractures of the atlas and the odontoid process graded as type II or III according to Anderson and D’Alonzo are diagnosed [1,2,3,4,5,6]. Distraction injuries resulting in atlantoaxial dissociation require separate observation These injuries may be accompanied by fractures of atlas and odontoid process as well [4, 6, 10]. BioMed Research International arteries, knowledge about the patterns of injury is essential and salvage has to be conducted quickly

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