• Jongpil Eun and Youngmin Oh.
• Department of Neurosurgery, Research Institute of Clinical Medicine of Jeonbuk National University, Jeonbuk National University Medical School and Hospital, Jeonju, Korea.
• Medicine (Baltimore). 2022 Oct 7; 101 (40): e30912e30912.

RationaleTraumatic lateral atlantoaxial dislocation (AAD) combined with an odontoid fracture is extremely rare. The standards applicable to management of the traumatic lateral AAD are still in flux due to the infrequency of this injury.Patient ConcernsWe present a unique case of traumatic lateral AAD combined with a type II odontoid fracture in a patient with ankylosing spondylitis (AS).DiagnosisSpinal computed tomography showed ankylosis of the entire spine from the sacroiliac joint to the cervical spine. On the cervical X-ray the head was rotated to the right with anterior subluxation of the C1 and odontoid tip relative to C2. The coronal computed tomography (CT) scan also revealed left lateral dislocation of C1 on C2 with a horizontal translation of the odontoid tip. On the axial and sagittal CT scan, the left C1 lateral mass was displaced anteriorly and locked by C2 body.InterventionsWe performed occipito-cervical fusion (OCF) after successful manual reduction under general anesthesia.OutcomesThe patient's recovery from surgery was uneventful and without complication. At the 3 year follow-up the patient was asymptomatic and reportedly satisfied with the surgery.LessonsTraumatic AAD with an odontoid fracture is an exceedingly uncommon cervical spine injury. A lateral subluxation with a type II odontoid fracture in a patient with AS is rarer still, so much so that this type of subluxation was not classifiable using any of the previously developed classification systems. In this patient with AS, posterior OCF with internal fixation was necessary to avoid hardware failure, particularly in light of the intensive stress caused by AS.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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