An elderly female with atlantoaxial dislocation corrected with cage insertion into the lateral atlantoaxial joints

Abstract

  As populations worldwide continue to age, the number of fractures in the vulnerable elderly is increasing. We report the case of an elderly patient with atlantoaxial dislocation that we corrected with cage insertion into the lateral atlantoaxial joints. The patient was an 87‒year‒old female who experienced neck pain for 11 months before coming to our department. The previous physician had diagnosed type II odontoid fracture and recommended halo vest fixation, but the patient rejected this option and chose cervical collar fixation. She also had a 2‒month history of skillful movement disorder in both hands, and gait disturbance. The imaging study on admission revealed that the displacement of the odontoid fracture had worsened, and spinal cord compression due to atlantoaxial dislocation was observed at the atlas. We performed surgery for C1‒C2 internal corrective fusion with an intra‒articular cage. The postoperative course was uneventful. The patient’s neurological condition also demonstrated acceptable recovery. In general, posterior correction for atlantoaxial subluxation is performed by the rod‒and‒screw pull‒up method, but in osteoporotic patients that method might cause an unexpected fracture or screw loosening. Our lift‒up method with an intra‒articular cage achieved the correction more safely. A careful image analysis of vertebral arteries should be conducted before surgery in such cases, and the safe exposure of the lateral atlantoaxial joints must be ensured.