Andreas Löwen (Aachen / DE), Miriam Unverzagt (Aachen / DE), Sebastian Schubert (Aachen / DE), Mohamad Agha Mahmoud (Aachen / DE), Christian Herren (Aachen / DE), Jil Frank (Aachen / DE), Philipp Kobbe (Aachen / DE), Frank Hildebrand (Aachen / DE), Miguel Pishnamaz (Aachen / DE)
The atlantoaxial dissociation injury is severe and often fatal at the scene of the accident. The term refers to a type of injuries that can easily be overlooked radiologically. These injuries are defined according to the direction of their instability as rotational, translational and axial, due to forced displacement of the neck resulting in a disruption of the transverse ligament and/or simultaneous disruption of the alar and apical ligaments.
Here we present three cases of young adults admitted to our hospital after sustaining this injury, two due to traffic accidents and one due to a sports injury. A 19-year-old woman was admitted after a severe high speed motor vehicle accident (MVA). The CT scan revealed among other injuries a distension of the C1/C2 joint on the right side up to 6 mm. The anterior atlanto-dental interval (ADI) appeared normal, however there were clear signs of a vertical subluxation and instability of C1/C2. An emergency surgery with posterior atlantoaxial fusion was performed.
The second case is a 27-year-old male who dove head first into shallow water on his vacation. He presented himself one week later with persistent neck pain without any neurological symptoms. The cervical radiographs showed a fracture of the right lateral mass of the atlas. It also displayed a widening of the ADI at a pathological 8 mm which showed to be reducible in dynamic fluoroscopy. The MRI confirmed the suspicion of the ruptured transverse ligament. The patient was surgically treated the following day. A postoperative CT scan showed a reconstitution of the ADI to normal values under 3mm.
The third case is a 21-year-old woman who sustained multiple injuries due to a MVA. The CT revealed a subluxation of the atlanto-occipital joints and a slight asymmetry in the atlantoaxial joints. The MRI showed a bilateral joint effusion in the atlantoaxial joints as a sign of instability. A C0-C2 fusion was performed. None of the patients showed any lasting neurological symptoms.
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