Atlantooccipital Dislocation – a Series of Six Patients and Topic Review

Česká verzia

Authors: V. Beneš III.; P. Barsa; P. Suchomel
Authors place of work: Neurochirurgické oddělení, Krajská nemocnice Liberec, a. s.
Published in the journal: Cesk Slov Neurol N 2013; 76/109(1): 81-85
Category: Short Communication

Summary

Objective:
Atlantooccipital dislocation (AOD) represents highly unstable and usually fatal injury of craniovertebral junction. Improved prehospital emergency care enables AOD sufferers to actually reach a hospital alive. Consequently, we decided to analyse our own series of AOD patients with the aim to highlight the difficulties associated with this injury.

Patients and methods:
We conducted a retrospective analysis of patients admitted during 1993–2010 with the diagnosis of AOD to Regional Hospital Liberec.

Results:
This series included 6 patients (4 women and 2 men, mean age 36.2 years). Upon arrival, all patients were intubated and ventilated. There was no sign of movement on the extremities. All patients had clear radiological findings of AOD. Five patients succumbed to the injury shortly after the diagnosis was established. The sixth patient underwent C0–C2 fusion but died after two months due to ventilator-associated pneumonia and sepsis.

Conclusion:
Our series confirmed high mortality among AOD patients. Spiral CT is the diagnostic test of choice. External orthosis can be used in some selected cases or as a temporary measure. Occipitocervical fusion is the only approach providing immediate and solid stabilization of craniovertebral junction.

Key words:
atlantooccipital dislocation – craniovertebral junction – mortality – spinal cord injury

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Zdroje

1. Blackwood NJ. III. Atlo-Occipital Dislocation: A Case of Fracture of the Atlas and Axis, and Forward Dislocation of the Occiput on the Spinal Column, Life being Maintained for Thirty-four Hours and Forty Minutes by Artificial Respiration, during which a Laminectomy was Performed upon the Third Cervical Vertebra. Ann Surg 1908; 47(5): 654–658.

2. Alker GJ jr, Oh YS, Leslie EV. High cervical spine and craniocervical junction injuries in fatal traffic accidents: a radiological study. Orthop Clin North Am 1978; 9(4): 1003–1010.

3. Bucholz RW, Burkhead WZ. The pathological anatomy of fatal atlanto-occipital dislocations. J Bone Joint Surg Am 1979; 61(2): 248–250.

4. Powers B, Miller MD, Kramer RS, Martinez S, Gehweiler JA jr. Traumatic anterior atlanto-occipital dislocation. Neurosurgery 1979; 4(1): 12–17.

5. Bellabarba C, Mirza SK, West GA, Mann FA, Dailey AT, Newell DW et al. Diagnosis and treatment of craniocervical dislocation in a series of 17 consecutive survivors during an 8-year period. J Neurosurg Spine 2006; 4(6): 429–440.

6. Horn EM, Feiz-Erfan I, Lekovic GP, Dickman CA, Sonntag VK, Theodore N. Survivors of occipitoatlantal dislocation injuries: imaging and clinical correlates. J Neurosurg Spine 2007; 6(2): 113–120.

7. Bulas DI, Fitz CR, Johnson DL. Traumatic atlanto-occipital dislocation in children. Radiology 1993; 188(1): 155–158.

8. DiBenedetto T, Lee CK. Traumatic atlanto-occipital instability. A case report with follow-up and a new diagnostic technique. Spine 1990; 15(6): 595–597.

9. Donahue DJ, Muhlbauer MS, Kaufman RA, Warner WC, Sanford RA. Childhood survival of atlantooccipital dislocation: underdiagnosis, recognition, treatment, and review of the literature. Pediatr Neurosurg 1994; 21(1): 105–111.

10. Grob D. Transarticular screw fixation for atlanto-occipital dislocation. Spine 2001; 26(6): 703–707.

11. Hosono N, Yonenobu K, Kawagoe K, Hirayama N, Ono K. Traumatic anterior atlanto-occipital dislocation. A case report with survival. Spine 1993; 18(6): 786–790.

12. Chattar-Cora D, Valenziano CP. Atlanto-occipital dislocation: a report of three patients and a review. J Orthop Trauma 2000; 14(5): 370–375.

13. Saeheng S, Phuenpathom N. Traumatic occipitoatlantal dislocation. Surg Neurol 2001; 55(1): 35–40.

14. Shamoun JM, Riddick L, Powell RW. Atlanto-occipital subluxation/dislocation: a „survivable“ injury in children. Am Surg 1999; 65(4): 317–320.

15. Harris JH Jr, Carson GC, Wagner LK. Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 1994; 162(4): 881–886.

16. Harris JH jr, Carson GC, Wagner LK, Kerr N. Radiologic diagnosis of traumatic occipitovertebral dissociation: 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 1994; 162(4): 887–892.

17. Traynelis VC, Marano GD, Dunker RO, Kaufman HH. Traumatic atlanto-occipital dislocation. Case report. J Neurosurg 1986; 65(6): 863–870.

18. de Oliveira E, Rhoton AL Jr, Peace D. Microsurgical anatomy of the region of the foramen magnum. Surg Neurol 1985; 24(3): 293–352.

19. Werne S. Studies in spontaneous atlas dislocation. Acta Orthop Scand Suppl 1957; 23: 1–150.

20. Pang D, Nemzek WR, Zovickian J. Atlanto-occipital dislocation – part 2: The clinical use of (occipital) condyle-C1 interval, comparison with other diagnostic methods, and the manifestation, management, and outcome of atlanto-occipital dislocation in children. Neurosurgery 2007; 61(5): 995–1015.

21. Palmer MT, Turney SZ. Tracheal rupture and atlanto-occipital dislocation: case report. J Trauma 1994; 37(2): 314–317.

22. Eismont FJ, Bohlman HH. Posterior atlanto-occipital dislocation with fractures of the atlas and odontoid process. J Bone Joint Surg Am 1978; 60(3): 397–399.

23. Rao G, Arthur AS, Apfelbaum RI. Circumferential fracture of the skull base causing craniocervical dislocation. Case report. J Neurosurg 2002; 97 (Suppl 1): 118–122.

24. Lesoin F, Blondel M, Dhellemmes P, Thomas CE, Viaud C, Jomin M. Post-traumatic atlanto-occipital dislocation revealed by sudden cardiopulmonary arrest. Lancet 1982; 2 (8295): 447–448.

25. Sponseller PD, Cass JR. Atlanto-occipital fusion for dislocation in children with neurologic preservation. A case report. Spine 1997; 22(3): 344–347.

26. Hosalkar HS, Cain EL, Horn D, Chin KR, Dormans JP, Drummond DS. Traumatic atlanto-occipital dislocation in children. J Bone Joint Surg Am 2005; 87(11): 2480–2488.

27. Suchomel P, Benes V. Traumatic Atlantooccipital Dislocation. In: Suchomel P, Choutka O (eds). Reconstruction of Upper Cervical Spine and Craniovertebral Junction. Berlin Heidelberg: Springer 2011: 139–144.

28. Dvorak MF, Fisher C, Boyd M, Johnson M, Greenhow R, Oxland TR. Anterior occiput-to-axis screw fixation: part I: a case report, description of a new technique, and anatomical feasibility analysis. Spine 2003; 28(3): E54–60.

29. Lee KM, Yeom JS, Lee JO, Buchowski JM, Park KW, Chang BS et al. Optimal trajectory for the atlantooccipital transarticular screw. Spine 2010; 35(16): 1562–1570.