# Novelty in Management of Traumatic Posterior Atlantoaxial Subluxation without Associated Fractures; A Case Report: Innovative Treatment for Atlantoaxial Subluxation

## TL;DR

This case report presents a rare instance of traumatic posterior atlantoaxial subluxation without fractures and describes an innovative treatment method using an impactor for closed reduction.

## Contribution

The paper introduces an innovative use of an impactor for closed reduction in a rare case of posterior atlantoaxial subluxation without fractures.

## Key findings

- A 23-year-old man with posterior C1-C2 subluxation was successfully treated using an impactor through the retropharynx.
- The odontoid process was successfully repositioned without fractures or surgical intervention.
- The case highlights the need for further study on innovative methods for treating rare atlantoaxial subluxations.

## Abstract

Background: Trauma is the main reason for Atlantoaxial subluxation in adults.
The subluxation without fractures is extremely rare. Also, posterior
atlantoaxial dislocation without odontoid fracture is extraordinarily
uncommon and regularly causes deadly spinal cord injury. Based on the
literature, there are few reports of approximately stressful posterior
atlantoaxial dislocation, with incomplete quadriplegia related to a spinal
cord injury.

Case Presentation: This report describes a 23-year-old Iranian man who was
involved in a motor-to-barrier accident. He was hemodynamically stable with
a Glasgow Coma Scale of 15/15 but exhibited cervical tenderness (C1-C2). A
CT scan revealed a posterior C1-C2 subluxation, with the odontoid process
anterior to the atlas and no fractures. Under general anesthesia, a
fluoroscopy guide, and C-ARM imaging monitoring, flexion of the head and
neck with traction was done. During the procedure, the odontoid process was
locked in the inferior of the anterior C1 arch, Therefore, we decided to
push back the odontoid process by using an Impactor through the retro
pharynx. The maneuver was successful, and the odontoid was placed in its
position.

Conclusion: The stability of the atlantoaxial complex relies on its anatomy,
which can be affected by trauma or congenital issues. Closed reduction
followed by C1-C2 arthrodesis is the preferred treatment. Innovative
methods, like using an impactor for closed reduction, need further study to
improve outcomes. Surgeons must evaluate each case based on the patient’s
specific situation.