Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, Xingtai, 054000, Hebei, China.
Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
Eur Spine J. 2019 Jun;28(Suppl 2):37-40. doi: 10.1007/s00586-018-5823-6. Epub 2018 Nov 17.
Atlantoaxial dislocation usually results from hyperextension trauma and is almost always accompanied by odontoid fracture and neurological symptoms. In most cases, patients with atlantoaxial dislocation die instantly. This is a rare report of posterior atlantoaxial dislocation without fracture and neurological symptoms effectively treated by transoral-posterior approach surgery, and only eleven similar cases have been previously reported.
To describe the very rare case of an adult posterior atlantoaxial dislocation patient without fracture who was neurologically treated using transoral-posterior approach surgery and to review the relevant literature.
A 52-year-old man riding a motorcycle was rear-ended by a car. Using X-ray, computed tomography (CT) scan and magnetic resonance imaging (MRI), he was diagnosed with posterior atlantoaxial dislocation without a related fracture or a significant change in spinal cord signal. Transoral-posterior approach surgery with sustained skull traction was used after failed closed reduction.
During a 6-month follow-up observation, the lateral cervical spine radiography and sagittal reconstructions of CT scans demonstrated no instability of the atlantoaxial complex. Few patients experience posterior atlantoaxial dislocation without a related fracture or spinal cord deficit. For a patient who experiences trauma with hyperextension, such as in rear-end collisions, X-ray, CT scan and MRI should be performed to ensure that this injury is diagnosed. It is necessary to perform surgery to recover atlantoaxial stability, even in the absence of fracture or neurological symptoms.
Transoral-posterior approach surgery is a safe and effective way to manage irreducible posterior atlantoaxial dislocation.
寰枢关节脱位通常由过伸性损伤引起，几乎总是伴有齿状突骨折和神经症状。大多数情况下，寰枢关节脱位的患者会立即死亡。这是一例罕见的无骨折和神经症状的寰枢关节后脱位患者，通过经口后路手术有效治疗的报告，之前仅报道过 11 例类似病例。
描述一例罕见的无骨折的成人寰枢关节后脱位患者，该患者通过经口后路手术进行神经治疗，并复习相关文献。
一名 52 岁男子骑摩托车被汽车追尾。通过 X 射线、计算机断层扫描（CT）和磁共振成像（MRI）检查，诊断为无相关骨折或脊髓信号明显变化的寰枢关节后脱位。在闭合复位失败后，采用持续颅骨牵引的经口后路手术。
在 6 个月的随访观察中，寰枢椎侧位 X 线片和 CT 矢状重建显示寰枢复合体无不稳定。很少有患者出现无相关骨折或脊髓缺损的寰枢关节后脱位。对于经历过伸展性创伤的患者，如追尾事故，应进行 X 射线、CT 扫描和 MRI 检查，以确保诊断出这种损伤。有必要进行手术以恢复寰枢关节的稳定性，即使没有骨折或神经症状。
经口后路手术是治疗不可复位的寰枢关节后脱位的一种安全有效的方法。
