Amin Md Rezaul, Rahman Md Ataur, Bari Mohammad Shahnawaz, Al-Amin Firoj Ahmed
Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Bangladesh.
Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Bangladesh.
Int J Surg Case Rep. 2023 Oct;111:108814. doi: 10.1016/j.ijscr.2023.108814. Epub 2023 Sep 14.
Traumatic subluxation of C2-C3 with Atlanto-Axial dislocation is very rare and uncommon condition. Only a very few case reported. What constitutes appropriate management in cases of traumatic C2-C3 subluxation with Atlato-axial dislocation is still controversial due to the infrequency of this injury. We managed a patient who had traumatic C2-C3 subluxation with Atlanto-axial dislocation following a history of trauma through posterior approach successfully.
A 45-year male day laborer presented with neck pain with progressive neurological deficit after two episodes of fall with heavy object within 1 year. Imaging revealed complete dislocation of C2 over C3 with Atlanto-Axial Dislocation. The patient was approached for posterior fixation with attempt to reduction per-operatively with skeletal traction and C1, C2, C3 joint distraction. After distraction of the joint, we achieved to do reduction of the C2-C3 and Atlanto-Axial joint. We did C1 lateral mass, C2 pedical and C3, C4 lateral mass screw and put a spacer in between C1-C2 facet joint. The patient was improved immediately after the operation. One year follow up shows, he was completely well. One year follow up shows in radiography proper alignment with fusion between C1, C2 and C3.
Traumatic subluxation of the C2 vertebra is due to fractures of the lamina, articular facets, pedicles, or pars interarticularis and was first described by Bouvier in1843. To the best of our knowledge there has been 3/4 cases reported till now with traumatic C2-C3 subluxation with AAD. In three similar cases before ours, one was reported to be reduced after 3 weeks of bidirectional cervical traction and another two cases were managed by open reduction and stabilization. We managed this rare case surgically successfully through posterior approach with good outcome.
Our management through posterior approach between C1 to C4 shows very good outcome with proper fusion. But it needs proper understanding the anatomy and mechanism of reduction by careful reading the image. Its needs more case description and management to establish a standard treatment for this type of disease.
伴有寰枢椎脱位的C2-C3创伤性半脱位是一种非常罕见的病症。仅有极少数病例报道。由于这种损伤的罕见性，对于伴有寰枢椎脱位的创伤性C2-C3半脱位病例，何种治疗方式恰当仍存在争议。我们成功地通过后路手术治疗了一名有创伤史且伴有寰枢椎脱位的C2-C3创伤性半脱位患者。
一名45岁男性日工，在1年内两次重物坠落伤后出现颈部疼痛并伴有进行性神经功能缺损。影像学检查显示C2相对于C3完全脱位并伴有寰枢椎脱位。对该患者采用后路固定，术中尝试通过颅骨牵引及C1、C2、C3关节撑开进行复位。关节撑开后，我们成功实现了C2-C3及寰枢关节的复位。我们置入了C1侧块、C2椎弓根及C3、C4侧块螺钉，并在C1-C2小关节间放置了一个间隔物。术后患者即刻病情改善。一年随访显示，他完全康复。一年随访的影像学检查显示C1、C2和C3之间融合良好且排列正常。
C2椎体的创伤性半脱位是由于椎板、关节面、椎弓根或关节突部骨折所致，最早由布维耶于1843年描述。据我们所知，迄今为止，仅有3/4例伴有寰枢椎脱位的创伤性C2-C3半脱位病例报道。在我们之前的3例类似病例中，1例经双向颈椎牵引3周后复位，另外2例采用切开复位及内固定治疗。我们通过后路手术成功地治疗了这一罕见病例，效果良好。
我们通过C1至C4的后路手术治疗取得了良好的融合效果及预后。但需要通过仔细研读影像来正确理解解剖结构及复位机制。需要更多的病例描述及治疗经验来建立针对此类疾病的标准治疗方案。
