Traumatic C2-C3 subluxation with atlanto-axial dislocation managed by posterior approach — A rare case report

INTRODUCTION AND IMPORTANCE: Traumatic subluxation of C2-C3 with Atlanto-Axial dislocation is very rare and uncommon condition. Only a very few case reported. What constitutes appropriate management in cases of traumatic C2-C3 subluxation with Atlato-axial dislocation is still controversial due to the infrequency of this injury. We managed a patient who had traumatic C2-C3 subluxation with Atlanto-axial dislocation following a history of trauma through posterior approach successfully. CASE DESCRIPTION: A 45-year male day laborer presented with neck pain with progressive neurological deficit after two episodes of fall with heavy object within 1 year. Imaging revealed complete dislocation of C2 over C3 with Atlanto-Axial Dislocation. The patient was approached for posterior fixation with attempt to reduction per-operatively with skeletal traction and C1, C2, C3 joint distraction. After distraction of the joint, we achieved to do reduction of the C2-C3 and Atlanto-Axial joint. We did C1 lateral mass, C2 pedical and C3, C4 lateral mass screw and put a spacer in between C1-C2 facet joint. The patient was improved immediately after the operation. One year follow up shows, he was completely well. One year follow up shows in radiography proper alignment with fusion between C1, C2 and C3. CLINICAL DISCUSSION: Traumatic subluxation of the C2 vertebra is due to fractures of the lamina, articular facets, pedicles, or pars interarticularis and was first described by Bouvier in1843. To the best of our knowledge there has been 3/4 cases reported till now with traumatic C2-C3 subluxation with AAD. In three similar cases before ours, one was reported to be reduced after 3 weeks of bidirectional cervical traction and another two cases were managed by open reduction and stabilization. We managed this rare case surgically successfully through posterior approach with good outcome. CONCLUSION: Our management through posterior approach between C1 to C4 shows very good outcome with proper fusion. But it needs proper understanding the anatomy and mechanism of reduction by careful reading the image. Its needs more case description and management to establish a standard treatment for this type of disease.