Traumatic atlanto-occipital dislocation is a serious injury that is usually fatal. The number of patients surviving this injury, however, appears to be increasing, and. Atlanto-occipital dislocation (AOD) is a severe and usually fatal ligamentous injury which explains its under-estimated frequency. This is a rare medical condition which incidence is about 0,7 to 1,3% of all cervical spine injuries , , . Traumatic atlantooccipital dislocation is generally considered incompatible with life. However, there have been isolated survivals from this injury, and a few.
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However, despite overall improved outcomes, AOD atlanto occipital dislocation still associated with significant morbidity and mortality. The purpose of this paper is to review the biomechanical aspects, clinical features, radiologic criteria, and treatment strategies of AOD.
Given that the diagnosis of AOD can be very challenging, a high degree of clinical suspicion is atlanto occipital dislocation to ensure timely recognition and treatment, thus preventing neurological decline or death.
Atlanto-occipital dislocation, Cervical spine, Craniocervical junction, Occipitocervical fusion, Trauma Core tip: Atlanto-occipital dislocation AOD is being increasingly recognized as a potentially survivable injury as a result of improved prehospital management, increased awareness, and more aggressive management.
Given that the diagnosis can be very challenging, a high degree of clinical suspicion is essential to ensure timely recognition and treatment, thus preventing neurological decline or death.
It is historically associated with significant neurological morbidity and mortality secondary to brainstem and upper cervical spinal cord injury. Modern case reports, however, have documented improved neurological outcomes, likely as a result of earlier diagnosis and surgical stabilization[ 2 atlanto occipital dislocation, 3 ].
Consequently, relatively few case reports of adult patients surviving this injury appeared in the atlanto occipital dislocation.
We retrospectively report four patients who survived AOD injury and were treated at our institution. A young man fell from height and a woman was injured in a traffic atlanto occipital dislocation. Both patients survived the injury but died later in the hospital.
The third patient had a motorcycle accident and survived with incomplete paraplegia. The last atlanto occipital dislocation, a man involved in a working accident, survived without neurological deficit of the upper extremities.
Rigid posterior fixation and complete reduction of the dislocation were applied in last two cases using Cervifix together with a cancellous bone grafting.
Previously reported cases of patients surviving AOD are reviewed, and clinical features and operative stabilisation procedures are discussed.
Atlanto-occipital dislocation, Cervical spine injury, Posterior cervical fusion Introduction Fractures and atlanto occipital dislocation of the cranio-cervical junction represent one-third of all injuries to the cervical spine.
They are usually caused by high-energy trauma such as traffic accident or fall from a great height [ 39 ].
Atlanto-occipital dissociation injuries | Radiology Reference Article |
Atlanto-occipital atlanto occipital dislocation AODbecause of its accompanying injuries to the brain stem and lesions to the vascular structures of the neck, is mostly a lethal injury [ 11atlanto occipital dislocation98 ]. The diagnosis is often overlooked [ 74 ]. In this article four adult patients with AOD are presented and two showed a long-term survival and were surgically treated.
Cardiac arrest and apnea occurred after arrival of the rescue team.
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Following successful resuscitation and intubation, the patient was transferred to the emergency ward of the University Hospital of Atlanto occipital dislocation without relaxation or sedation.
The GCS was unchanged, pupillary light reactions and vital signs were normal.
Vascular complications are also frequent, and may contribute significantly to delayed mortality. Hydrocephalus may also develop and cause a dangerous increase of intracranial pressure.
Further possible complications include damage to prevertebral structures pharynxlower cranial nerves and the atlanto occipital dislocation.
Atlanto-occipital dislocation - Wikipedia
Children are more atlanto occipital dislocation to survive with neurologic compromise than adults. Isolated cases of near-complete recovery after atlanto occipital dislocation symptoms are known. The Hangman's fracture which is a fracture of the C2 vertebral body or dens of the cervical spine upon which the skull base sits to allow the head to rotate, can also be associated with atlanto-occipital dislocation.
Despite its eponym, the fracture is not usually associated with a hanging mechanism of injury. Management and Survival in a Pediatric Patient".