Traumatic Atlantoaxial Spondyloptosis Associated with Displaced Odontoid Fracture: Complete Reduction via Posterior Approach Using "Joint Remodeling" Technique

World Neurosurg. 2018 Feb;110:609-613. doi: 10.1016/j.wneu.2017.09.097.


Background: Atlantoaxial spondyloptosis (AAS), which is defined as complete displacement of facets of atlas anterior to the facets of axis such that there is no contact between the 2 articulating surfaces, is an extremely rare manifestation of atlantoaxial instability. The reason for an extreme rarity of traumatic AAS is probably the severity of injury in traumatic AAS that is usually incompatible to life. It represents the most severe form of atlantoaxial dislocation, and complete reduction in such a case presents a real technical challenge because of the interlocking of C1-C2 facets. Cranial traction fails to achieve reduction in such cases.

Case description: In this report, we describe a case of traumatic odontoid fracture associated with AAS and discuss our technique of complete reduction of deformity via posterior approach. An 11-year-old child presented to us 4 months after a road traffic accident with progressive spastic quadriparesis. On evaluation, displaced type II odontoid fracture with AAS was detected. The patient underwent surgery via posterior approach. The techniques of "joint manipulation" and "joint remodeling" were used to achieve complete reduction of spondyloptosis. Postoperative imaging showed complete reduction of deformity. The patient also improved neurologically after surgery.

Conclusion: This case report aims to present the ability of "joint manipulation" and "joint remodeling" techniques in achieving excellent reduction in even one of the most difficult post-traumatic deformities that affect the craniovertebral junction.

Keywords: Joint manipulation; Joint remodeling; Posterior approach; Traumatic atlantoaxial spondyloptosis; Traumatic odontoid fracture.

Publication types

  • Case Reports

MeSH terms

  • Accidents, Traffic
  • Atlanto-Axial Joint / diagnostic imaging
  • Atlanto-Axial Joint / surgery*
  • Child
  • Fracture Fixation, Internal* / methods
  • Humans
  • Male
  • Odontoid Process / diagnostic imaging
  • Odontoid Process / injuries*
  • Odontoid Process / surgery*
  • Quadriplegia / complications
  • Quadriplegia / diagnostic imaging
  • Quadriplegia / surgery
  • Spinal Fractures / complications
  • Spinal Fractures / diagnostic imaging
  • Spinal Fractures / surgery*
  • Spondylolisthesis / complications
  • Spondylolisthesis / diagnostic imaging
  • Spondylolisthesis / surgery*
  • Traction / methods