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  • Title: Atlantoaxial manual realignment in a patient with traumatic atlantoaxial joint disruption.
    Author: Goel A, Figueiredo A, Maheshwari S, Shah A.
    Journal: J Clin Neurosci; 2010 May; 17(5):672-3. PubMed ID: 20223670.
    Abstract:
    We report a patient with complex traumatic translatory atlantoaxial dislocation, who we treated by joint exposure and reduction of the dislocation by facet manipulation and subsequent plate and screw atlantoaxial fixation. A 28-year-old male had fallen 7.6m (25 feet), and following the fall had severe neck pain but no neurological deficit. Investigations revealed a fracture at the base of the odontoid process and posterior displacement of the entire atlas over the axis, resulting in a translatory atlantoaxial dislocation. Head traction failed as he developed severe vertigo following its application. The patient was operated upon in a prone position. We opened the atlantoaxial joint and realigned the facets using distraction and manipulation techniques and secured the joint using a plate and screw interarticular method. The patient tolerated the treatment well and was symptom-free after 28 months. Postoperative images showed good craniovertebral alignment. Although technically challenging, direct manipulation of the facets of the atlas and axis can result in excellent craniovertebral realignment.
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