The Spine Journal 14 (2014) 1067–1069
Traumatic atlantoaxial dislocation with type II odontoid fracture A 50-year-old man fell from a height. Physical examination disclosed a deep laceration on the forehead. Neurologic examination was normal. Cervical radiograph and computed tomography scans showed a complete posterolateral dislocation of the atlas with respect to the axis and a type II odontoid fracture (Fig. 1). The patient was treated by skull traction with an initial weight of 3 kg. This was gradually increased to 12 kg over 4 days, until the dislocation was reduced (Fig. 2). Under fluoroscopic guidance, the patient was treated by percutaneous odontoid screw fixation using the operative method that we had described in detail
elsewhere (Fig. 3, Left) [1]. One week postoperatively, the patient was discharged. He was asked to wear a cervical brace for the next 3 months. However, 1 month later, the patient returned because of odynophagia. Cervical radiograph showed a loose screw (Fig. 3, Right). No atlantoaxial dislocation was observed. A revision procedure was carried out through posterior atlantoaxial transarticular screw fixation and interlaminar wiring with an autologous iliac crest bone graft (Fig. 4). The patient returned to his normal work, free of symptoms except for some cervical rotation loss. Reference [1] Chi YL, Wang XY, Xu HZ, et al. Management of odontoid fractures with percutaneous anterior odontoid screw fixation. Eur Spine J 2007;16:1157–64.
Fig. 1. Initial images showing posterolateral complete atlantoaxial dislocation with type II odontoid fracture. 1529-9430/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2013.12.022
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N.F. Tian et al. / The Spine Journal 14 (2014) 1067–1069
Fig. 2. (Left) Radiograph and (Middle) CT scan showing successful reduction achieved through skull traction. (Right) T2-weighted sagittal MRI demonstrating a normal spinal cord. CT, computed tomography; MRI, magnetic resonance imaging.
Nai F. Tian, MDa Hua Z. Xu, MDa Yao S. Wu, MDb Yong L. Chi, MDa a Department of Orthopaedic Surgery Second Affiliated Hospital of Wenzhou Medical University 109 Xueyuanxi Rd, Wenzhou Zhejiang 325000, China
b
Department of Orthopaedics Second Affiliated Hospital School of Medicine Zhejiang University, 88 Jiefang Rd Hangzhou, Zhejiang, 310009, China FDA device/drug status: Not applicable. Author disclosures: NFT: Nothing to disclose. HZX: Nothing to disclose. YSW: Nothing to disclose. YLC: Nothing to disclose.
Fig. 3. (Left) Postoperative lateral radiograph confirming odontoid screw in place. (Right) Failure of the odontoid screw fixation 1 month postoperatively.
N.F. Tian et al. / The Spine Journal 14 (2014) 1067–1069
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Fig. 4. (Top) Cervical radiographs confirming internal fixation in place after revision surgery using posterior transarticular screw fixation and interlaminar fusion. (Bottom) Computed tomographic reconstructions showing obvious bone resorption of the odontoid.
Traumatic atlantoaxial dislocation with type II odontoid fracture A 50-year-old man fell from a height. Physical examination disclosed a deep laceration on the forehead. Neurologic examination was normal. Cervical radiograph and computed tomography scans showed a complete posterolateral dislocation of the atlas with respect to the axis and a type II odontoid fracture (Fig. 1). The patient was treated by skull traction with an initial weight of 3 kg. This was gradually increased to 12 kg over 4 days, until the dislocation was reduced (Fig. 2). Under fluoroscopic guidance, the patient was treated by percutaneous odontoid screw fixation using the operative method that we had described in detail
elsewhere (Fig. 3, Left) [1]. One week postoperatively, the patient was discharged. He was asked to wear a cervical brace for the next 3 months. However, 1 month later, the patient returned because of odynophagia. Cervical radiograph showed a loose screw (Fig. 3, Right). No atlantoaxial dislocation was observed. A revision procedure was carried out through posterior atlantoaxial transarticular screw fixation and interlaminar wiring with an autologous iliac crest bone graft (Fig. 4). The patient returned to his normal work, free of symptoms except for some cervical rotation loss. Reference [1] Chi YL, Wang XY, Xu HZ, et al. Management of odontoid fractures with percutaneous anterior odontoid screw fixation. Eur Spine J 2007;16:1157–64.
Fig. 1. Initial images showing posterolateral complete atlantoaxial dislocation with type II odontoid fracture. 1529-9430/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2013.12.022
1068
N.F. Tian et al. / The Spine Journal 14 (2014) 1067–1069
Fig. 2. (Left) Radiograph and (Middle) CT scan showing successful reduction achieved through skull traction. (Right) T2-weighted sagittal MRI demonstrating a normal spinal cord. CT, computed tomography; MRI, magnetic resonance imaging.
Nai F. Tian, MDa Hua Z. Xu, MDa Yao S. Wu, MDb Yong L. Chi, MDa a Department of Orthopaedic Surgery Second Affiliated Hospital of Wenzhou Medical University 109 Xueyuanxi Rd, Wenzhou Zhejiang 325000, China
b
Department of Orthopaedics Second Affiliated Hospital School of Medicine Zhejiang University, 88 Jiefang Rd Hangzhou, Zhejiang, 310009, China FDA device/drug status: Not applicable. Author disclosures: NFT: Nothing to disclose. HZX: Nothing to disclose. YSW: Nothing to disclose. YLC: Nothing to disclose.
Fig. 3. (Left) Postoperative lateral radiograph confirming odontoid screw in place. (Right) Failure of the odontoid screw fixation 1 month postoperatively.
N.F. Tian et al. / The Spine Journal 14 (2014) 1067–1069
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Fig. 4. (Top) Cervical radiographs confirming internal fixation in place after revision surgery using posterior transarticular screw fixation and interlaminar fusion. (Bottom) Computed tomographic reconstructions showing obvious bone resorption of the odontoid.
