title: Atlantoaxial manual realignment in a patient with traumatic atlantoaxial joint disruption.
abstract: We report a patient with complex traumatic translatory atlantoaxial dislocation, who we treated by joint exposure and reduction of the dislocation by facet manipulation and subsequent plate and screw atlantoaxial fixation. A 28-year-old male had fallen 7.6m (25 feet), and following the fall had severe neck pain but no neurological deficit. Investigations revealed a fracture at the base of the odontoid process and posterior displacement of the entire atlas over the axis, resulting in a translatory atlantoaxial dislocation. Head traction failed as he developed severe vertigo following its application. The patient was operated upon in a prone position. We opened the atlantoaxial joint and realigned the facets using distraction and manipulation techniques and secured the joint using a plate and screw interarticular method. The patient tolerated the treatment well and was symptom-free after 28 months. Postoperative images showed good craniovertebral alignment. Although technically challenging, direct manipulation of the facets of the atlas and axis can result in excellent craniovertebral realignment.
authors.affiliation: Department of Neurosurgery, King Edward VII Memorial Hospital and Seth G. S. Medical College, Acharya Donde Marg, Parel, Mumbai 400 012, India. atulgoel62@hotmail.com <atulgoel62@hotmail.com>
authors.forename: Atul
authors.initials: A
authors.lastname: Goel
authors.forename: Antonio
authors.initials: A
authors.lastname: Figueiredo
authors.forename: Shradha
authors.initials: S
authors.lastname: Maheshwari
authors.forename: Abhidha
authors.initials: A
authors.lastname: Shah
mesh_terms: D000058:Accidental Falls; D000328:Adult; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D005593:Fracture Fixation, Internal; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome