A case of anterior arch fracture of the atlas associated with C1 laminectomy

Background: Spontaneous anterior arch fracture of the atlas after a C1 laminectomy (CIL) is an extremely rare complication.

Case description: A 72-year-old male presented with the sudden onset of neck pain. His prior history included; a CIL for atlantoaxial subluxation, shunt closure for a spinal dural arteriovenous fistula at C3, a cervical laminoplasty from C3 to C6 for stenosis, and a prior anterior C4/5 and C5/6 fusion 14 years ago. Once the computed tomography documented a right C1 anterior arch fracture, and occipital-cervical fusion was performed utilizing C2 laminar screws and C4 pedicle screws with halo-vest placement. Postoperatively, the neck pain resolved and he remained stable.

Conclusion: Neurosurgeons should be aware of the risk of anterior arch fractures following a CIL and may alternatively consider a C1 laminoplasty in the future.