Irreducible Atlanto-Axial Dislocation in Neglected Odontoid Fracture Treated with Single Stage Anterior Release and Posterior Instrumented Fusion

Anterior transcervical release with posterior atlantoaxial fixation for neglected malunited type II odontoid fractures

Background:

Type 2 odontoid fractures are associated with a high rate of nonunion without surgical treatment. If neglected, they may become fixed in an abnormal position, causing progressive myelopathy. Conventionally, odontoidectomy or transoral release is performed to relieve symptoms in such cases. Here, were report our experience with a transcervical approach for odontoid release (i.e., of a chronically fractured dens) followed by a posterior C1–C2 fusion.

Methods:

The 11 patients (2017–2021) retrospectively included; in this study, all had a history of remote trauma and the radiological appearance of an old odontoid fracture that was displaced and could not be reduced with traction. There were eight males and three females who averaged 52.6 years of age.

Results:

All 11 patients underwent anterior retropharyngeal release with a C4–C5 level incision followed by a posterior C1–C2 fusion. The mean Japanese orthopedic association on presentation was 9.9 ± 2.7 which improved to 13.8 ± 2.7 on final follow-up (P < 0.01). Patients were followed an average of 9.6 months ± 4.4 (mean ± SD) postoperatively during which time they all clinically improved.

Conclusion:

Anterior release through a retropharyngeal approach coupled with posterior C1–C2 instrumentation proved to be an effective alternative to the traditional transoral approach to treat a chronic malunited odontoid fracture.

Surgical treatment of neglected C2 odontoid process fracture with anterior atlantoaxial dislocation

We report a case of the atlantoaxial (C1-2) deformity secondary to a neglected C2 odontoid fracture that was successfully treated with 3-stage operation performed in one session.

Occipitocervical fixation using Ransford loop for neglected posttraumatic odontoid fracture with atlantoaxial dislocation: A technical note

Background:

To relieve the onset of new clinical symptoms, it is important to recognize and treat previously neglected odontoid fractures. However, many hospitals in developing countries do not have the equipment or surgical expertise to adequately manage these lesions.

Case Description:

A 31-year-old male presented with paresthesias/quadriparesis attributed to an accident sustained 6 months earlier. The cervical magnetic resonance image revealed atlantoaxial subluxation type 2. Following a laminectomy and occipitocervical fusion with a Ransford loop, the patient’s symptoms significantly improved.

Conclusion:

Straight forward laminectomy and occipitocervical fusion with a Ransford loop may adequately treat selected cases of neglected atlantoaxial subluxation in a developing country.

Anterior Release and Anterior Reconstruction for a Neglected Osteoporotic Odontoid Fracture

A 70 years old lady presented to us with history of a fall 3 months prior. She had suffered a type 2 odontoid fracture with atlantoaxial dislocation, that was not reducible by traction. She had symptoms of neck pain with inability to hold the neck upright. The patient was subsequently planned for anterior release and reduction of odontoid fracture dislocation with posterior stabilization in the same sitting. The patient was treated with cervical skeletal traction and immobilized. However, she developed occipital sore during the period and was mobilized with brace after which she developed myelopathic symptoms and gait disturbance due to the collapse of fracture segment. The patient was planned for anterior release and fixation with contoured reconstruction plate fixing C1 lateral mass to the lateral mass on the right side and C1 lateral mass to C2 body on the left side primarily with distraction of the C1-C2 joint by autologous tricortical iliac bone graft. The posterior stabilization was planned after healing of the sore, and the patient was counseled for the same. However, the patient was lost on follow-up and returned at 3-month postoperative period with collapse of the graft, resubluxation of C1-C2 segment, and failure of anterior fixation. The standard modality of treatment for such cases includes an anterior release of contracted soft tissues and ligaments and posterior stabilization with fusion in a single setting. However, it is the posterior fixation that stabilizes the fracture and prevents it from redislocation. Anterior fixation as a stand-alone treatment in osteoporotic bone has high risks of failure due to severe posterior tensile stresses. This article describes the importance of posterior fixation in osteoporotic bone based on our experience.

Occipitocervical Fusion and Posterior Fossa Decompression in Neglected Jefferson Fracture-Dislocation of Atlas Associated With Odontoid Peg Fracture: A Case Report

Background

Only a few cases of traumatic atlantoaxial fracture-dislocation have been reported, and neglected cases are seldom found because of the fatal nature of this condition.

Methods

We reported a neglected case of Jefferson fracture-dislocation associated with type II displaced odontoid peg fracture which was nonambulatory and myelopathic. A surgical plan involving posterior fossa decompression and laminectomy of the posterior arch of atlas following posterior spinal instrumentation was then conducted.

Results

Patient experienced marked neurologic recovery and was able to stand and walk with assistance during the early postoperative period.

Conclusions

This procedure may be an effective alternative treatment in neglected cases.