Traumatic C2-C3 Coronal Dislocation with Vertebral Artery Injury: Case Report and Literature Review

Abstract

Introduction: The coronal subluxation of C2-C3 (lateral leisthesis or non-hangman fracture) is extremely rare and difficult to manage. In this paper, we report a case of a 21-year-old male who came to the ER after a motor vehicle accident (MVA) with C2-C3 lateral leisthesis and, surprisingly, mild neurological symptoms.
 Method: This systematic review was conducted following the recommendations of the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) checklist. On January 1, 2022, a comprehensive electronic search was conducted through Scopus, PubMed, and Web of Science databases to retrieve original studies.
 Results: Seven articles were found reporting on non-hangman traumatic C2/C3 subluxation, with only two cases reporting coronal subluxation or lateral listhesis of C2 over C3. The first case was reported by Rajasekaran et al. Singh reported the second case. Both cases were unilateral facet dislocations with no radiological evidence of intervertebral disc disruption or herniation. We will report the third case in the literature of a non-hangman C2/C3 coronal dislocation. The patient underwent intraoperative manual traction under continuous neurophysiology monitoring. After the satisfactory reduction, fixation was carried out using lateral mass and pars screws from C1 to C3. Postoperatively, the patient recovered well, showed no signs of motor impairment during examination, and was discharged on the fifth day.
 Conclusion The impact of cervical spine injury is tremendous at every level. Management of cervical spine dislocation injury is full of controversies. The C2/C3 traumatic coronal translation with no disc involvement and unilateral facet dislocation may have a better outcome.