[Atlanto-occipital instability due to the transverse atlas ligament rupture. Report of a case with symptoms persisting for 21 years].

The authors describe a case of a judo sportsman with a cervical spine injury sustained 21 years earlier. The injury initiated characteristic sensations of severe generalized pain with paraesthesias recurring whenever he was hit on the top of the head. In February 2001 the patient fell on his head, which resulted in tetraplegia with a complete sensory loss. The symptoms disappeared after ten minutes. Plain radiography, CT and MRI performed after this episode revealed occipitalization of the atlas and C1-C2 instability due to a rupture of the transverse atlas ligament. The patient underwent surgery by the posterior approach: decompression of the foramen magnum, fixation of the occiput and C-2 (with wiring and a bone graft). At one-year follow-up after the surgery the patient had limited movements of the neck without neurological symptoms. Plain radiograms confirmed stability of the occipitocervical fusion. There was no recurrence of the preoperative symptoms.