Atlanto-axial subluxation/dislocation

Case contributed by Dr Eric F Greif


Pedestrian struck by car and became unresponsive.

Patient Data

Age: 55 years
Gender: Female

There are acute fractures involving the bilateral pedicles of C2 as follows:

  • Left side: acute fracture involving the left anterior superior articulating process of C2 extending to anterior aspect of left transverse process of C2. Left-sided fracture is comminuted.
  • Right side: small avulsion or chip fractures of the anterior aspect of the right pedicle of C2.

There is a non-displaced fracture through the right transverse process of C7. No gross impingement of either the C2 or C7 transverse foramina.

There are additional small avulsion fractures between the dens and anterior arch of C1 on the left (best visualized on axial images). The donor site likely originates from C1 and is secondary to a transverse ligament injury. The den is subluxed approximately 6 mm posteriorly, causing impression upon the cord. This is likely secondary to the transverse ligamentous injury/avulsion.

Endotracheal tube is noted.

Case Discussion

The patient was struck by a car. There was traumatic cardiac arrest and acute shock secondary to trauma, possibly spinal shock. The cervical spine CT demonstrates atlantoaxial subluxation secondary to a traumatic transverse ligamentous avulsion injury. The patient presented with quadriplegia and urinary/bowl incontinence from the cervical spinal cord injury. The patient died three days later.

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Case information

rID: 29659
Published: 12th Jun 2014
Last edited: 14th Aug 2019
System: Spine
Inclusion in quiz mode: Included

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