Traumatic injury of the transverse atlantal ligament

Abstract

Introduction. In some cases C2 may suffer only rotational dislocation around its own axis (dens), causing no increase in the atlantodental interval (ADI), making it difficult to diagnose the instability in static radiographies. Objective. To report a case of atlanto-axial traumatic subluxation, without bony injury or displacement, in which the diagnosis cannot be achieved through conventional radiology and computed tomography, and discuss the types of transverse ligament injuries, its diagnosis, the instability and their treatment. Methods.A 61-year-old man, victim of head (occipital), complaining neck. Static radiographies and CT scan of cervical spine were performed, demonstrating no abnormalities. Flexion and extension cervical radiography revealed an increase of ADI in flexion, indicating instability and damage to the transverse atlantal ligament (TAL). The MRI of the cervical spine demonstrated the discontinuity of the TAL, configuring an injury to the structure of the ligament. The patient underwent to early surgery with C1-C2 fixation using the Goel-Harms’technique. Results. The diagnosis could be revealed only in dynamic radiographs or MRI study. The patient presented complete improvement of symptoms. Conclusions. The use of cervical dynamic radiography and / or magnetic resonance imaging allowed the diagnosis of instability and visualization of the TAL injury, avoiding the lack of diagnosis with its consequences. The MRI allows a direct view of the ligament injury, their classification and the prognostic evaluation of the injury, guiding the therapy, surgical or conservative.