Delayed Spinal Myelopathy Following Atlanto-Axial Fracture Dislocation

T rauma t i c at lanto-axial f racture with dislocation of the odontoid process results in mos t cases in immediate quadriplegia and has a high morta l i ty . I n a few instances, however, neurological complicat ions are slight or no t apparen t and the fracture dislocation is no t suspected at the time. The late onset of a syndrome compat ible with spinal m y e l o p a t h y could then present diagnostic problems in which an under ly ing lesion of this na ture might not be suspected; this would of course be par t icular ly likely if a period of years separated the t r auma and the emergence of symptoms. The l i terature contains a few records of wha t m a y be te rmed delayed m y e l o p a t h y of this type , appear ing 1 to 38 years af ter the injury. 12'8'7'9'12'13'16-19 The case presented herein is, we believe, the 14th to be recorded, and presents a symptom-f ree interval of no less than 28 years.