Management of neurologically intact traumatic posterior atlantoaxial dislocation with odontoid fracture and bilateral locked facets: a case report and literature review.

BACKGROUND

Traumatic posterior atlantoaxial dislocation (TPAD) with an associated odontoid fracture is exceedingly rare, typically resulting from high-energy trauma such as high-velocity road traffic accidents or falls from height. This report details a previously undescribed case of an old TPAD combined with a Type II odontoid fracture and bilateral locked facets in a patient who remained neurologically intact. We also systematically review the literature on the diagnosis and management of this injury pattern to provide evidence-based guidance for clinical decisions.

CASE PRESENTATION: A 67-year-old woman presented with significant neck pain and stiffness, but no neurological deficit, following a traffic accident. After four years of failed conservative management, she underwent posterior release, reduction, and screw-rod fixation. Postoperatively and throughout follow-up, she experienced complete resolution of symptoms and demonstrated improved alignment on imaging, with no intraoperative or postoperative complications.

CONCLUSIONS

The surgical management of old dislocation with bilateral locked facets presents substantial technical challenges. For this specific type of TPAD, a single posterior approach incorporating facet release, reduction, and screw-rod fixation represents an effective and safe option, achieving satisfactory clinical outcomes.