The Spine Journal 14 (2014) 2518–2520
Traumatic atlantoaxial dislocation with an old Type II odontoid fracture A 37-year-old man with a 20-year-history of odontoid fracture fell from stairs 3 months before admission. He was sent to our department because of the progressive deterioration in the stiffness of the limbs. Physical examination revealed that the muscle strength of the limbs decreased to score 3 and bilateral Hoffman and Babinski signs were positive. Three-dimensional computed tomography scans demonstrated a complete dorsal dislocation of the axis with respect to the atlas, and an old Type II odontoid fracture (Fig. 1) was established based on the Anderson and D’Alonzo classification [1]. Magnetic resonance imaging showed that the spinal cord was severely compressed (Fig. 2). A posterior occiput and C2 pedicle screw fixation was performed according to the guidance of Resnick et al. [2]. Postoperative threedimensional computed tomography disclosed an anatomical reduction of the C1–C2 complex (Fig. 3), and magnetic resonance imaging showed that satisfactory atlantoaxial reduction and decompression of the spinal cord were achieved (Fig. 4). Ten days after the operation, he was discharged. During the 2year follow-up, he recovered well and leads a normal life. Acknowledgments This study was supported by the grant from National Natural Science Foundation of China (No.81172409 to AW). References [1] Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am 1974;56:1663–74.
[2] Resnick DK, Lapsiwala S, Trost GR. Anatomic suitability of the C1C2 complex for pedicle screw fixation. Spine 2002;27:1724–32.
Zhonghua Li, MDa Hongliang Zhang, MDa Xiaolei Li, MDb Xiaoqian Liu, MDc Yanming Huang, MDa Anhua Wu, MDa a Department of Neurosurgery First Affiliated Hospital of China Medical University China.No.155, North Nanjing Street, Heping District Shenyang 110001, Liaoning People’s Republic of China b Department of Pharmacology College of Basic Medical Sciences Harbin Medical University-Daqing China.No.1, Xinyang Street, Gaoxin District Daqing 163319, Heilongjiang People’s Republic of China c Department of Neurosurgery Fourth Affiliated Hospital of Harbin Medical University China.No.37, Yiyuan Street, Nangang District Haerbin 150001, Heilongjiang People’s Republic of China FDA device/drug status: Not applicable. Author disclosures: ZL: Grant: National Natural Science Foundation of China (No.81172409 to AW) (F, Paid directly to institution). HZ: Nothing to disclose. XLi: Nothing to disclose. XLiu: Nothing to disclose. YH: Nothing to disclose. AW: Grant: National Natural Science Foundation of China (No.81172409 to AW) (F, Paid directly to institution). The disclosure key can be found on the Table of Contents and at www. TheSpineJournalOnline.com. The authors declared no potential conflict of interests with respect to the research, authorship, and/or publication of this article.
Fig. 1. Preoperative images revealing a complete atlantoaxial dislocation and an old Type II odontoid avulsion fracture. 1529-9430/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2014.06.006
Z. Li et al. / The Spine Journal 14 (2014) 2518–2520
Fig. 2. Preoperative magnetic resonance imaging showing the severely compressed spinal cord.
Fig. 3. Postoperative three-dimensional computed tomography disclosing an anatomical reduction of the C1–C2 complex.
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Z. Li et al. / The Spine Journal 14 (2014) 2518–2520
Fig. 4. Postoperative sagittal and axial magnetic resonance imaging demonstrating the release of the compression in the spinal cord.
Traumatic atlantoaxial dislocation with an old Type II odontoid fracture A 37-year-old man with a 20-year-history of odontoid fracture fell from stairs 3 months before admission. He was sent to our department because of the progressive deterioration in the stiffness of the limbs. Physical examination revealed that the muscle strength of the limbs decreased to score 3 and bilateral Hoffman and Babinski signs were positive. Three-dimensional computed tomography scans demonstrated a complete dorsal dislocation of the axis with respect to the atlas, and an old Type II odontoid fracture (Fig. 1) was established based on the Anderson and D’Alonzo classification [1]. Magnetic resonance imaging showed that the spinal cord was severely compressed (Fig. 2). A posterior occiput and C2 pedicle screw fixation was performed according to the guidance of Resnick et al. [2]. Postoperative threedimensional computed tomography disclosed an anatomical reduction of the C1–C2 complex (Fig. 3), and magnetic resonance imaging showed that satisfactory atlantoaxial reduction and decompression of the spinal cord were achieved (Fig. 4). Ten days after the operation, he was discharged. During the 2year follow-up, he recovered well and leads a normal life. Acknowledgments This study was supported by the grant from National Natural Science Foundation of China (No.81172409 to AW). References [1] Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am 1974;56:1663–74.
[2] Resnick DK, Lapsiwala S, Trost GR. Anatomic suitability of the C1C2 complex for pedicle screw fixation. Spine 2002;27:1724–32.
Zhonghua Li, MDa Hongliang Zhang, MDa Xiaolei Li, MDb Xiaoqian Liu, MDc Yanming Huang, MDa Anhua Wu, MDa a Department of Neurosurgery First Affiliated Hospital of China Medical University China.No.155, North Nanjing Street, Heping District Shenyang 110001, Liaoning People’s Republic of China b Department of Pharmacology College of Basic Medical Sciences Harbin Medical University-Daqing China.No.1, Xinyang Street, Gaoxin District Daqing 163319, Heilongjiang People’s Republic of China c Department of Neurosurgery Fourth Affiliated Hospital of Harbin Medical University China.No.37, Yiyuan Street, Nangang District Haerbin 150001, Heilongjiang People’s Republic of China FDA device/drug status: Not applicable. Author disclosures: ZL: Grant: National Natural Science Foundation of China (No.81172409 to AW) (F, Paid directly to institution). HZ: Nothing to disclose. XLi: Nothing to disclose. XLiu: Nothing to disclose. YH: Nothing to disclose. AW: Grant: National Natural Science Foundation of China (No.81172409 to AW) (F, Paid directly to institution). The disclosure key can be found on the Table of Contents and at www. TheSpineJournalOnline.com. The authors declared no potential conflict of interests with respect to the research, authorship, and/or publication of this article.
Fig. 1. Preoperative images revealing a complete atlantoaxial dislocation and an old Type II odontoid avulsion fracture. 1529-9430/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2014.06.006
Z. Li et al. / The Spine Journal 14 (2014) 2518–2520
Fig. 2. Preoperative magnetic resonance imaging showing the severely compressed spinal cord.
Fig. 3. Postoperative three-dimensional computed tomography disclosing an anatomical reduction of the C1–C2 complex.
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Z. Li et al. / The Spine Journal 14 (2014) 2518–2520
Fig. 4. Postoperative sagittal and axial magnetic resonance imaging demonstrating the release of the compression in the spinal cord.
