Traumatic posterior atlantoaxial dislocation without an associated fracture: a PRISMA-compliant case-based systematic review and meta-analysis
Traumatic posterior atlantoaxial dislocation (TPAD) without an associated fracture is a rare and challenging spinal injury. This PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant case-based systematic review and meta-analysis aimed to comprehensively explore TPAD,...
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| Format: | Article |
| Language: | English |
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Korean Spine Society
2024-12-01
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| Series: | Asian Spine Journal |
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| Online Access: | http://asianspinejournal.org/upload/pdf/asj-2024-0331.pdf |
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| author | Mahmoud Fouad Ibrahim Ahmed Shawky Abdelgawaad Essam Mohammed El-Morshidy Amr Hatem Mohamed El-Meshtawy Mohammad El-Sharkawi |
| author_facet | Mahmoud Fouad Ibrahim Ahmed Shawky Abdelgawaad Essam Mohammed El-Morshidy Amr Hatem Mohamed El-Meshtawy Mohammad El-Sharkawi |
| author_sort | Mahmoud Fouad Ibrahim |
| collection | DOAJ |
| description | Traumatic posterior atlantoaxial dislocation (TPAD) without an associated fracture is a rare and challenging spinal injury. This PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant case-based systematic review and meta-analysis aimed to comprehensively explore TPAD, covering clinical presentation, diagnosis, treatment, and clinical and radiological outcomes. Following the presentation of a case of TPAD without an associated fracture, we conducted a systematic search of electronic databases, including Scopus, PubMed, and Web of Science, from inception through October 2023, without language restrictions. Cases involving dislocations due to congenital anomalies or inflammatory processes were excluded. The search yielded 31 eligible cases of TPAD without an associated fracture. The majority (81%) of the cases were males, with traffic accidents being the leading cause (87%). Notably, 52% of the cases presented without any neurological deficits. Regarding treatment approaches, 23% of the cases were managed through closed reduction alone, 32% required fusion following closed reduction, and 45% underwent open reduction and fusion. A time delay exceeding 7.5 days was associated with a significantly higher risk of closed reduction failure (odds ratio, 56.463; p=0.011). This review identified key management strategies for TRAD without fracture, informed by the available evidence. Optimal management entails prompt closed reduction under C-arm while monitoring neurological status once hemodynamic stability is achieved. Surgical fusion is indicated for cases with magnetic resonance imaging-confirmed transverse ligament rupture or residual instability. If closed reduction fails, open reduction and fusion should be carried out. Posterior C1–C2 screws fixation is the preferred fusion technique, providing high levels of safety and biomechanical stability. |
| format | Article |
| id | doaj-art-7029bcfdcd5c4ede8ea73658fb6ba221 |
| institution | OA Journals |
| issn | 1976-1902 1976-7846 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Korean Spine Society |
| record_format | Article |
| series | Asian Spine Journal |
| spelling | doaj-art-7029bcfdcd5c4ede8ea73658fb6ba2212025-08-20T01:52:19ZengKorean Spine SocietyAsian Spine Journal1976-19021976-78462024-12-0118688990210.31616/asj.2024.03311684Traumatic posterior atlantoaxial dislocation without an associated fracture: a PRISMA-compliant case-based systematic review and meta-analysisMahmoud Fouad Ibrahim0Ahmed Shawky Abdelgawaad1Essam Mohammed El-Morshidy2Amr Hatem3Mohamed El-Meshtawy4Mohammad El-Sharkawi5 Department of Orthopaedic and Trauma Surgery, Assiut University Hospitals, Assiut, Egypt Department of Orthopaedic and Trauma Surgery, Assiut University Hospitals, Assiut, Egypt Department of Orthopaedic and Trauma Surgery, Assiut University Hospitals, Assiut, Egypt Department of Orthopaedic and Trauma Surgery, Assiut University Hospitals, Assiut, Egypt Department of Orthopaedic and Trauma Surgery, Assiut University Hospitals, Assiut, Egypt Department of Orthopaedic and Trauma Surgery, Assiut University Hospitals, Assiut, EgyptTraumatic posterior atlantoaxial dislocation (TPAD) without an associated fracture is a rare and challenging spinal injury. This PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant case-based systematic review and meta-analysis aimed to comprehensively explore TPAD, covering clinical presentation, diagnosis, treatment, and clinical and radiological outcomes. Following the presentation of a case of TPAD without an associated fracture, we conducted a systematic search of electronic databases, including Scopus, PubMed, and Web of Science, from inception through October 2023, without language restrictions. Cases involving dislocations due to congenital anomalies or inflammatory processes were excluded. The search yielded 31 eligible cases of TPAD without an associated fracture. The majority (81%) of the cases were males, with traffic accidents being the leading cause (87%). Notably, 52% of the cases presented without any neurological deficits. Regarding treatment approaches, 23% of the cases were managed through closed reduction alone, 32% required fusion following closed reduction, and 45% underwent open reduction and fusion. A time delay exceeding 7.5 days was associated with a significantly higher risk of closed reduction failure (odds ratio, 56.463; p=0.011). This review identified key management strategies for TRAD without fracture, informed by the available evidence. Optimal management entails prompt closed reduction under C-arm while monitoring neurological status once hemodynamic stability is achieved. Surgical fusion is indicated for cases with magnetic resonance imaging-confirmed transverse ligament rupture or residual instability. If closed reduction fails, open reduction and fusion should be carried out. Posterior C1–C2 screws fixation is the preferred fusion technique, providing high levels of safety and biomechanical stability.http://asianspinejournal.org/upload/pdf/asj-2024-0331.pdfatlantoaxial dislocationspinal injuriestraumaclosed reduction |
| spellingShingle | Mahmoud Fouad Ibrahim Ahmed Shawky Abdelgawaad Essam Mohammed El-Morshidy Amr Hatem Mohamed El-Meshtawy Mohammad El-Sharkawi Traumatic posterior atlantoaxial dislocation without an associated fracture: a PRISMA-compliant case-based systematic review and meta-analysis Asian Spine Journal atlantoaxial dislocation spinal injuries trauma closed reduction |
| title | Traumatic posterior atlantoaxial dislocation without an associated fracture: a PRISMA-compliant case-based systematic review and meta-analysis |
| title_full | Traumatic posterior atlantoaxial dislocation without an associated fracture: a PRISMA-compliant case-based systematic review and meta-analysis |
| title_fullStr | Traumatic posterior atlantoaxial dislocation without an associated fracture: a PRISMA-compliant case-based systematic review and meta-analysis |
| title_full_unstemmed | Traumatic posterior atlantoaxial dislocation without an associated fracture: a PRISMA-compliant case-based systematic review and meta-analysis |
| title_short | Traumatic posterior atlantoaxial dislocation without an associated fracture: a PRISMA-compliant case-based systematic review and meta-analysis |
| title_sort | traumatic posterior atlantoaxial dislocation without an associated fracture a prisma compliant case based systematic review and meta analysis |
| topic | atlantoaxial dislocation spinal injuries trauma closed reduction |
| url | http://asianspinejournal.org/upload/pdf/asj-2024-0331.pdf |
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