Sonntag procedure in Atlanto-odontoid fractures type III in restoring Atlanto-axial complex stability: A case report

INTRODUCTION AND IMPORTANCE: Fractures of the second cervical vertebrae (C2) and its odontoid process account for one of the most frequent cervical spine injuries that cause significant mortality and morbidity. The goal of injury treatment is to restore atlantoaxial complex stability. This article reports a young male patient aged 19 years who underwent surgical treatment due to odontoid fractures type III. CASE PRESENTATION: A 19-year-old male patient came with a chief complaint of weakness in the upper and lower extremities for 3 weeks before admission. The patient underwent a series of physical and radiological examinations and was diagnosed with atlanto-odontoid fracture dislocation Anderson and D'Alonzo classification type III and motoric aphasia due to traumatic subdural hygroma. The patient underwent temporary cervical traction with Garden-Wells tongs and planned for posterior stabilization with the Sonntag procedure. Three and six months follow-ups showed significant clinical improvement in range of motion (ROM). CLINICAL DISCUSSION: Surgical modalities of stabilization are more commonly chosen in patients with type II and type III odontoid fractures. We performed posterior stabilization with C1-C2 fusion using a modified Gallie (Sonntag) procedure and trans articular screw placement using the Magerl technique. The Gallie procedure was chosen because it could limit atlas displacement effectively which significantly improved Neck Disability Index (NDI) and visual analog score (VAS). CONCLUSION: We presented a rare case of Atlanto-odontoid fractures treated with a surgical procedure using a posterior approach that resulted in a excellent outcomes.