Untreated Anderson Type II Odontoid Fracture with Severe Delayed Atlanto-Axial Dislocation, Lateral Mass Misleading Signs of Fusion, and Posterior Surgical Approach: A Case Report

V Chiarella,U A Arcidiacono,M Giugliano,G Santoro,A Di Bartolomeo,A G Ruggeri

doi:10.31586/ujn.2022.189

V Chiarella, U A Arcidiacono + Show 4 more

Open Access

https://doi.org/10.31586/ujn.2022.189

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Abstract

We present a case of untreated type II odontoid fracture, which evolved in severe dislocation 18 months later. Delayed dislocations in untreated type II odontoid fractures are already reported in literature. The singularity of our case is that CT-scan showed signs of fusion in the right C1-C2 articulation, which could have required a more complex surgical procedure to realign the upper cervical spine. Surprisingly, a CT scan performed in the extension position showed complete mobility of C1 and allowed us to perform a one stage posterior fixation. We want to highline both the importance of treating an Anderson type II fracture to prevent dislocation (acute or delayed), and the possibility to perform a flexion-extension CT scan to project a better surgical plan.

Highlights

Despite the frequency of odontoid Anderson type II fracture, there are controversies about optimal management strategy in this condition
We present a case of untreated type II odontoid fracture, which evolved in severe dislocation 18 months later
She underwent a cervical CT scan (Figure 1) showing Anderson type II odontoid fracture with severe atlanto-axial anterior dislocation and fusion signs in the right C1-C2 articulation

Summary

Introduction

Despite the frequency of odontoid Anderson type II fracture, there are controversies about optimal management strategy in this condition. Delayed dislocations in untreated type II odontoid fractures are already reported in literature.[4,5] The singularity of our case is that CT-scan showed signs of fusion in the right C1-C2 articulation, which could have required a more complex surgical procedure to realign the upper cervical spine. This case was written according to the CARE statement guidelines, and the patient gave her consent to this publication.[6]. She underwent a cervical CT scan (Figure 1) showing Anderson type II odontoid fracture with severe atlanto-axial anterior dislocation and fusion signs in the right C1-C2 articulation.

Discussion

Conclusions