Jefferson fracture with disruption of the transverse ligament. A case report.

A 20-year-old male incurred a vertex injury of the skull, disruption of the transverse ligament of the atlas, and a Jefferson fracture--lateral displacement of the lateral masses of the atlas in relation to the lateral margins of the second cervical vertebra. The combination of Jefferson fracture with transverse ligament disruption was not appreciated initially (or even late) because of the head injury. The hospital course was complicated by the patient's initial unconsciousness and restlessness caused by associated intracranial injury. Roentgenograms in all views of the cervical spine were essential to its recognition and had to be carefully examined. Laminograms of the cervical spine showed a small anterolateral fragment on the right at the location of the tubercle attachment of the transverse ligament. Surgical stabilization is essential in this complex injury to protect the spinal cord from damage by subluxation and/or dislocation at the C1-C2 interval. Posterior cervical fusion of C1-C2 was performed at 4 1/2 weeks postinjury to allow time for healing of the ring of the atlas.