Meyer Type III Vertical Atlantoaxial Distraction With Complete Ligamentous Disruption: A Case Report and Surgical Management

Background: Vertical atlantoaxial distraction (AAD) represents a rare and severe form of craniocervical injury caused by high-energy trauma. It involves vertical separation of the atlas and axis due to complete rupture of the ligamentous stabilizers and poses an immediate risk of neurological or vascular compromise. Case Description: A 33-year-old male sustained multiple injuries following a suicidal jump from 10 meters, including a Type III vertical AAD with 6 mm distraction between the C1 and C2 lateral masses. Imaging revealed complete rupture of the alar, apical, and posterior longitudinal ligaments, bilateral facet joint capsule disruption, and a Gehweiler Type I anterior arch fracture of C1. A traumatic dural tear with suspected CSF leak was also identified. Initial anterior stabilization was performed with mini-fragment screws, followed by delayed posterior C1/C2 fusion via transarticular screws one week later due to clinical instability. Intraoperative correction of a 10° C1-C2 rotational deformity was achieved, and dural repair was completed using TachoSil and muscle graft. The patient remained neurologically intact and had an uneventful recovery. Follow-up imaging at one year demonstrated stable alignment of the construct without signs of hardware loosening, failure, or new neurological findings. At the 6-year follow-up, the patient remained neurologically intact with preserved cervical rotation up to 50° Conclusion: This case highlights the diagnostic complexity and management challenges associated with vertical AAD. A classification-based surgical strategy supported by high-resolution imaging and intraoperative navigation led to successful stabilization and excellent neurological outcome.