Abstract
Introduction
Injuries to the cervical spine are often described as neurologically catastrophic events with a very low survival rate. Lesions of the C3–C7 segment are the most common (∼ 80%) followed by the segment C1–C2 (20%). Injuries to the cervical spine are of great importance, both for its severity as well as the neurological implications they entail. The delay in diagnosis and treatment has been reported as a negative prognostic factor associated with poor outcome. Cases of atlantoaxial dislocations have been reported without neurological deficit at presentation and in long-term follow-up so these injuries could be unnoticed at the emergency department. When neurological damage is not evident at presentation symptoms are generally unspecific, such as, suboccipital pain when axial cranial pressure is applied movement, or at passive rotation the patient spontaneously assumes a stiff neck, contracting sternocleidomastoid and trapezius muscles.
Materials and Methods
A 28-year-old male patient without relevant medical history was a victim of physical assault on August 15, 2012, suffering cranial and cervical trauma, and was discharged, he showed no neurological symptoms then. Six weeks after discharge, he began with paresthesias of thoracic limbs and subsequently with diminished muscle strength, which was gradually decreasing. Imaging demonstrated atlantoaxial subluxation. Posterior instrumentation with transfacetary lag screws at C1/C2 was performed.
Results One year after surgery, the patient presents without neurological deficit, absence of stiff neck and denies pain when mobilization of the neck or axial compression is applied. Fusion was achieved with no further complications.
Conclusion
The diagnosis of traumatic subluxation should be suspected in the presence of torticollis and neck pain associated with cervical trauma. However, atlantoaxial dislocation can occur in the absence of any clinical signs so it should be systematically considered as a diagnosis an should be excluded in any polytraumatized. We suggest that simple radiographic measurements (ADI and Powers Index). When the instability of the C1/C2 joint is diagnosed, early reduction, and fusion is recommended as the definitive treatment.