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Management of Intra Operative Over- Reduction of Traumatic AAD with Fracture of C1-C2 Vertebrae: Case Report & Review of Literature

Intra operative reduction of dislocated C1-C2 joints involves joint manipulation and varying degrees of distraction, compression and extension components. This holds good in cases of congenital Atlanto-axial dislocation (AAD) with Basilar invagination (BI). In cases of traumatic AAD associated with fracture of C1-C2 vertebrae, the joints may be hypermobile and grossly unstable because of the injured osseous-ligamentous complex. Distraction in these cases can cause traction on the brain stem or cervical cord, as well as over reduction of the C1-C2 joints leading to spinal canal compromise. We report a case of traumatic AAD (translation / rotatory/ lateral tilt) with fractures of C1-C2 vertebrae. While performing intra operative reduction, there was over reduction of C1-C2 joints. The management and available literature is discussed.