Case Report: Fracture C1 & C2 (Type 3) vertebrae with Atlanto-Axial Dislocation (AAD)

(AirCmde) KK Yadav¹, Vinayak M², Satish PV³

¹Senior Consultant Neurosurgery & Spine Surgery, Kauvery Hospital Marathalli Bangalore

²Consultant Neurosurgery, Spine & Interventional Surgery, Kauvery Hospital Marathalli Bangalore

³Consultant & HOD Radiology, Kauvery Hospital Marathalli Bangalore

Case Report: Fracture C1 & C2 (Type 3) vertebrae with Atlanto-Axial Dislocation (AAD)

(AirCmde) KK Yadav¹, Vinayak M², Satish PV³

¹Senior Consultant Neurosurgery & Spine Surgery, Kauvery Hospital Marathalli Bangalore

²Consultant Neurosurgery, Spine & Interventional Surgery, Kauvery Hospital Marathalli Bangalore

³Consultant & HOD Radiology, Kauvery Hospital Marathalli Bangalore

Case Presentation

A 44-year-old male sustained neck trauma following a RTA on 17 Feb 2025 at his native in West Bengal. Following this he noted severe pain in the nape of neck with associated stiffness and inability to move his neck at all. He was managed at various centers locally with conservative measures. He finally reached our center on 21 Mar 2025, without even a Philadelphia collar.

On Examination

Revealed him to be having severe stiffness, deep tenderness and paraspinal muscle spasm in the nape of neck. His neck movements were completely restricted and he had to hold his head on any change of position from lying to sitting to standing and vice versa. There were no neurological deficits except equivocal planters.

Imaging

X-ray, CT scan and MRI od Cervico-vertebral junction were carried out which revealed a displaced & communited fractures of the base and the body of the odontoid as well as body of C2 vertebrae. Also noted was subluxation of the lateral Atlanto-axial joint on the left side. There were also undisplaced fracture involving the inferior articular process of the atlas (C1) vertebrae.

Diagnosis: Fracture C1 & C2 (Type 3) Vertebrae with Atlanto-Axial Dislocation (AAD)

Management

Patient was immediately put on a Philadelphia collar, counselled & prepared for early surgery as he was a classic case of C1, C2 Fracture with AAD & impending quadriplegia/quadriparesis.

Surgery

We proceeded with posterior approach with head on a fixator. We did a wide exposure, excision of posterior arch of C1 vertebrae, distraction/reduction with fusion of C1-C2-C3 under GA.

Post-operatively

He recovered well, ambulated the very next day and discharged thereafter on Philadelphia collar. He remained on follow up and thereafter returned to his native in West Bengal.

Images

Pre-operative, Surgical Image, Pre-operative & Post-operative Video.