title: Unique paradoxical atlantoaxial dislocation with C1-C2 facet diastases and isolated ligamentous injury to the craniovertebral junction without neurological deficits: A case report.
abstract: METHODS
  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.
  
  
  BACKGROUND
  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.
authors.affiliation: Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India.
authors.forename: Aniruddha Thekkatte
authors.initials: AT
authors.lastname: Jagannatha
authors.affiliation: Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India.
authors.forename: Umesh
authors.initials: U
authors.lastname: Srikantha
authors.affiliation: Department of Neurosurgery, R L Jalappa Medical college, Tamaka, Kolar, Karnataka, India.
authors.forename: Papa Raja
authors.initials: PR
authors.lastname: Murthy
authors.affiliation: Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India.
authors.forename: Ravi Gopal
authors.initials: RG
authors.lastname: Varma
authors.affiliation: Department of Neurosurgery, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India.
authors.forename: Hariprakash
authors.initials: H
authors.lastname: Chakravarthy
authors.affiliation: Senior Professor and Director, M S Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, India.
authors.forename: Alangar Sathya
authors.initials: AS
authors.lastname: Hegde
keywords: Awake positioning; C1-C2 fusion; Posterior atlantoaxial dislocation; Vertebral artery dissection; Whiplash; pure ligamentous injury
references.citation: Skeletal Radiol. 2008 Apr;37(4):361-6
references.pmid: 18259747
references.citation: J Bone Joint Surg Am. 1969 Apr;51(3):561-6
references.pmid: 5781589
references.citation: Arch Orthop Trauma Surg. 2011 May;131(5):681-5
references.pmid: 21207046
references.citation: Neurosurgery. 2010 Mar;66(3 Suppl):7-12
references.pmid: 20173531
references.citation: Clin Rheumatol. 1994 Sep;13(3):492-5
references.pmid: 7835016
references.citation: Stroke. 2005 Jul;36(7):1575-80
references.pmid: 15933263
references.citation: Eur Spine J. 2010 Jul;19 Suppl 2:S118-23
references.pmid: 19714372
references.citation: Spine (Phila Pa 1976). 1991 May;16(5):587-9
references.pmid: 2053005