Novelty in Management of Traumatic Posterior Atlantoaxial Subluxation without Associated Fractures; A Case Report

Innovative Treatment for Atlantoaxial Subluxation

Abstract

Background: Trauma is the main reason for Atlantoaxial subluxation in adults. The subluxation without fractures is extremely rare. Also, posterior atlantoaxial dislocation without odontoid fracture is extraordinarily uncommon and regularly causes deadly spinal cord injury. Based on the literature, there are few reports of approximately stressful posterior atlantoaxial dislocation, with incomplete quadriplegia related to a spinal cord injury. Case Presentation: This report describes a 23-year-old Iranian man who was involved in a motor-to-barrier accident. He was hemodynamically stable with a Glasgow Coma Scale of 15/15 but exhibited cervical tenderness (C1-C2). A CT scan revealed a posterior C1-C2 subluxation, with the odontoid process anterior to the atlas and no fractures. Under general anesthesia, a fluoroscopy guide, and C-ARM imaging monitoring, flexion of the head and neck with traction was done. During the procedure, the odontoid process was locked in the inferior of the anterior C1 arch, Therefore, we decided to push back the odontoid process by using an Impactor through the retro pharynx. The maneuver was successful, and the odontoid was placed in its position. Conclusion: The stability of the atlantoaxial complex relies on its anatomy, which can be affected by trauma or congenital issues. Closed reduction followed by C1-C2 arthrodesis is the preferred treatment. Innovative methods, like using an impactor for closed reduction, need further study to improve outcomes. Surgeons must evaluate each case based on the patient’s specific situation.