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Journal of Craniovertebral Junction and Spine
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CASE REPORT
Year : 2013  |  Volume : 4  |  Issue : 2  |  Page : 90-93

Unique paradoxical atlantoaxial dislocation with C1-C2 facet diastases and isolated ligamentous injury to the craniovertebral junction without neurological deficits: A case report


1 Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, India
2 Department of Neurosurgery, R L Jalappa Medical college, Tamaka, Kolar, Karnataka, India
3 Senior Professor and Director, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, India

Correspondence Address:
Aniruddha Thekkatte Jagannatha
Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, New BEL Road-54, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-8237.128542

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Study design: Retrospective review of the case file. Objective: The primary objective was to report this rare case and discuss the mechanism of dislocation and technique of manual closed reduction of C1-C2 vertebrae in such scenarios. Summary of background data: Posterior atlantoaxial dislocation (AAD) is extremely rare and a few cases have been reported in English literature. This young man sustained a high speed car accident and survived an extreme hyperextension injury to the craniovertebral junction (CVJ) without any neurological deficits. On evaluation for neck pain he was noted with a dislocated odontoid lying in front of Atlas. There was C1-C2 facet diastases. No bony injury was noted at CVJ. Transverse axial ligament (TAL) was intact. He underwent a successful awake reduction of the dislocation. The joint had to be manually distracted, realigned, and released under the guidance of fluoroscopy. This was followed by single stage C1-C2 Goel's fusion with awake prone positioning. This patient was able to go back to work at the end of 3 months (GOS 5). Conclusions: This condition is extremely rare, can be carefully reduced manually under adequate neuromonitoring, and requires C1-C2 fusion in the same sitting.


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