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.