Traumatic Posterolateral Atlantoaxial Dislocation with Type II Odontoid Fracture: Case Report

Background context: The combination of atlantoaxial joint dislocation and odontoid process fracture is usually a lethal injury and as a result, reports of survivors are rare. In the last thirty years only fifteen clinical cases have been described. Purpose: We present a case of a 30 year old patient with a traumatic posterolateral atlantoaxial dislocation (type V dislocation based on the Fielding classification), type II odontoid fracture and initial complete tetraplegia, who survived for 10 months after the accident. Study design of case report Methods: A review of the medical records since the time of initial hospital admission throughout follow-up was performed. Results: The immediate first aid, uninterrupted rescue time, transfers to a level I trauma centre and the absence of cerebral vascular lesions contributed to the patient ́s survival. The injury was immediately treated by reduction and internal stabilization of the occiput to C2-C4. After the surgery and transfer to rehabilitation clinic the complete tetraplegia did not recover and communication by the patient was only possible by eyeand eyelid movement. Due to severe complications resulting finally from the complete tetraplegia (cardiac arrhythmia, recurrent pneumonias leading to endocarditis, peritonitis and sepsis), the patient died after 10 months. Conclusion: This rare case and presented management strategy underlines the significantly increased mortality rate with high cord injuries.