Yan Tingfei, Qi Deshuang, Ni Haoyu, Xie Bingyong, Chang Jianchao, Zhang Li, Song Peiwen, Shen Cailiang, Yang Haisong, Shi Guodong, Yu Haiming, Dong Fulong
1Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui.
2Department of Orthopedics, 411 Hospital, Shanghai University, Shanghai.
J Neurosurg Spine. 2025 May 9;43(1):98-107. doi: 10.3171/2025.2.SPINE24876. Print 2025 Jul 1.
Traumatic posterior atlantoaxial dislocation (TPAD) is uncommon, and related research is very limited. By analyzing the imaging characteristics of the anterior arch-odontoid process-transverse ligament complex in patients, the authors classify the outcomes of TPAD and elucidate its mechanisms of injury.
This is a retrospective review of CT and MRI data on patients with TPAD treated at two clinical centers from June 2014 to March 2024. Through analysis and statistics on injuries to the anterior arch, odontoid process, and transverse ligament complex, the authors proposed a new classification method based on different injuries to these structures on imaging. Additionally, they discuss the role of hyperflexion and hyperextension injuries in the formation of TPAD.
The different injuries to the anterior arch-odontoid process-transverse ligament complex on imaging were classified into four types of TPAD: fracture-free TPAD (type I), odontoid process fracture TPAD (type II), anterior arch fracture TPAD (type III), and compound fracture TPAD (type IV); the latter three types are referred to as "fracture-associated TPAD." Considering the significant role of the transverse ligament in injuries, these four fracture types were further divided into two subtypes based on transverse ligament integrity (i.e., intact or injured). Among the 41 patients included in the study, there were 2 cases of fracture-free TPAD (i.e., 1 type Ia case and 1 type Ib case) and 39 cases of fracture-associated TPAD (i.e., 31 cases of odontoid process fracture TPAD, including 18 type IIa cases and 3 type IIb cases; 5 cases of anterior arch fracture TPAD, including 3 type IIIa cases and 2 type IIIb cases; and 3 cases of compound fracture TPAD, including 2 type IVa cases and 1 type IVb case).
Based on the imaging classification method for different injuries to the anterior arch-odontoid process-transverse ligament complex, TPAD injuries demonstrate a higher degree of alignment, facilitating a comprehensive understanding of these injuries. Hyperflexion and hyperextension are the primary mechanisms in TPAD injuries, with the integrity of the transverse ligament playing a crucial role and guiding treatment principles.
创伤性寰枢椎后脱位（TPAD）并不常见，相关研究非常有限。通过分析患者前弓-齿突-横韧带复合体的影像学特征，作者对TPAD的结果进行分类并阐明其损伤机制。
这是一项对2014年6月至2024年3月在两个临床中心接受治疗的TPAD患者的CT和MRI数据的回顾性研究。通过对前弓、齿突和横韧带复合体损伤的分析和统计，作者基于影像学上这些结构的不同损伤提出了一种新的分类方法。此外，他们还讨论了过屈和过伸损伤在TPAD形成中的作用。
影像学上前弓-齿突-横韧带复合体的不同损伤被分为四种类型的TPAD：无骨折型TPAD（I型）、齿突骨折型TPAD（II型）、前弓骨折型TPAD（III型）和复合骨折型TPAD（IV型）；后三种类型被称为“骨折相关型TPAD”。考虑到横韧带在损伤中的重要作用，这四种骨折类型根据横韧带的完整性（即完整或损伤）进一步分为两个亚型。在纳入研究的41例患者中，有2例无骨折型TPAD（即1例Ia型和1例Ib型）和39例骨折相关型TPAD（即31例齿突骨折型TPAD，包括18例IIa型和3例IIb型；5例前弓骨折型TPAD，包括3例IIIa型和2例IIIb型；3例复合骨折型TPAD，包括2例IVa型和1例IVb型）。
基于前弓-齿突-横韧带复合体不同损伤的影像学分类方法，TPAD损伤显示出更高的对线程度，有助于全面了解这些损伤。过屈和过伸是TPAD损伤的主要机制，横韧带的完整性起着关键作用并指导治疗原则。
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