[Atlanto-occipital Dislocation-A Challenge with Respect to Making the Diagnosis and Treatment]

Overview

Journal Unfallchirurgie (Heidelb)

Specialty Emergency Medicine

Date 2023 Dec 29

PMID 38156996

Authors

Kolja Gelse

Matthias Guggenberger

Affiliations

Soon will be listed here.

Abstract

Background: The correct diagnosis and treatment of the atlanto-occipital dislocation (AOD) remains a major challenge.

Objective: To evaluate the different radiological diagnostic criteria for AOD and discuss potential treatment strategies based on a case with AOD and additional fracture of the atlas.

Material And Methods: A 29-year-old male patient is presented who suffered from AOD with concomitant fracture of the anterior and posterior arches of the atlas with rotational atlantoaxial dislocation following an accident in forestry. The following parameters were evaluated for the diagnosis and assessment of postoperative reduction: Powers ratio, the X‑lines-method, Wackenheim line, basion-dens interval (BDI), basion-axial interval (BAI) and occipital condyle-C1 interval (CCI).

Results: Stabilization was performed by occipitocervical spondylodesis from C0 to C2/3. For final reduction it was necessary to reduce the malrotation of the atlas. In the presented case, the revised CCI proved to be a sensitive and valid yet practical parameter. Powers' ratio and the BDI were less suited for assessing the diagnosis. The X‑lines-method, Wackenheim line and the BAI did not adequately detect the pathological situation.

Discussion: The AOD is a severe injury requiring immediate correct diagnosis for later adequate treatment results. Among the published parameters, the revised CCI proved to be a practical and valid parameter to detect AOD. For definitive treatment, the operative occipitocervical stabilization is regarded as the method of choice.

References

Ehlinger M, Charles Y, Adam P, Bierry G, Dosch J, Steib J . Survivor of a traumatic atlanto-occipital dislocation. Orthop Traumatol Surg Res. 2011; 97(3):335-40. DOI: 10.1016/j.otsr.2010.10.001. View

Fisher C, Sun J, Dvorak M . Recognition and management of atlanto-occipital dislocation: improving survival from an often fatal condition. Can J Surg. 2002; 44(6):412-20. PMC: 3692674. View

Daneshi A, Rahimizadeh A, Fattahi A, Darvishnia S, Masoudi O, Mohajeri S . Our experiences in patients with atlanto-occipital dislocation: A case series with literature review. J Craniovertebr Junction Spine. 2023; 14(1):103-107. PMC: 10198206. DOI: 10.4103/jcvjs.jcvjs_152_22. View

Mendenhall S, Sivaganesan A, Mistry A, Sivasubramaniam P, McGirt M, Devin C . Traumatic atlantooccipital dislocation: comprehensive assessment of mortality, neurologic improvement, and patient-reported outcomes at a Level 1 trauma center over 15 years. Spine J. 2015; 15(11):2385-95. DOI: 10.1016/j.spinee.2015.07.003. View

Theodore N, Aarabi B, Dhall S, Gelb D, Hurlbert R, Rozzelle C . Transportation of patients with acute traumatic cervical spine injuries. Neurosurgery. 2013; 72 Suppl 2:35-9. DOI: 10.1227/NEU.0b013e318276edc5. View

Gire J, Roberto R, Bobinski M, Klineberg E, Durbin-Johnson B . The utility and accuracy of computed tomography in the diagnosis of occipitocervical dissociation. Spine J. 2013; 13(5):510-9. DOI: 10.1016/j.spinee.2013.01.023. View

Martinez-Del-Campo E, Kalb S, Soriano-Baron H, Turner J, Neal M, Uschold T . Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle-C1 interval. J Neurosurg Spine. 2015; 24(4):535-45. DOI: 10.3171/2015.6.SPINE15226. View

Pang D, Nemzek W, Zovickian J . Atlanto-occipital dislocation: part 1--normal occipital condyle-C1 interval in 89 children. Neurosurgery. 2007; 61(3):514-21. DOI: 10.1227/01.NEU.0000290897.77448.1F. View

Powers B, Miller M, Kramer R, Martinez S, Gehweiler Jr J . Traumatic anterior atlanto-occipital dislocation. Neurosurgery. 1979; 4(1):12-7. DOI: 10.1227/00006123-197901000-00004. View

10.

Rojas C, Bertozzi J, Martinez C, Whitlow J . Reassessment of the craniocervical junction: normal values on CT. AJNR Am J Neuroradiol. 2007; 28(9):1819-23. PMC: 8134200. DOI: 10.3174/ajnr.A0660. View

11.

Wholey M, BRUWER A, BAKER Jr H . The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology. 1958; 71(3):350-6. DOI: 10.1148/71.3.350. View

12.

HARRIS Jr J, Carson G, Wagner L . Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol. 1994; 162(4):881-6. DOI: 10.2214/ajr.162.4.8141012. View

13.

Lee C, Woodring J, Goldstein S, Daniel T, Young A, Tibbs P . Evaluation of traumatic atlantooccipital dislocations. AJNR Am J Neuroradiol. 1987; 8(1):19-26. PMC: 8334021. View

14.

Pang D, Nemzek W, 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. DOI: 10.1227/01.neu.0000303196.87672.78. View

15.

Theodore N, Aarabi B, Dhall S, Gelb D, Hurlbert R, Rozzelle C . The diagnosis and management of traumatic atlanto-occipital dislocation injuries. Neurosurgery. 2013; 72 Suppl 2:114-26. DOI: 10.1227/NEU.0b013e31827765e0. View

16.

HARRIS Jr J, Carson G, Wagner L, 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):887-92. DOI: 10.2214/ajr.162.4.8141013. View

17.

Izeki M, Neo M, Takemoto M, Fujibayashi S, Ito H, Nagai K . The O-C2 angle established at occipito-cervical fusion dictates the patient's destiny in terms of postoperative dyspnea and/or dysphagia. Eur Spine J. 2013; 23(2):328-36. PMC: 3906459. DOI: 10.1007/s00586-013-2963-6. View

18.

Bellabarba C, Mirza S, West G, Mann F, Dailey A, Newell D . Diagnosis and treatment of craniocervical dislocation in a series of 17 consecutive survivors during an 8-year period. J Neurosurg Spine. 2006; 4(6):429-40. DOI: 10.3171/spi.2006.4.6.429. View

19.

Grin A, Lvov I, Talypov A, Kordonskiy A, Godkov I, Khushnazarov U . Factors Affecting the Outcomes of Traumatic Atlanto-Occipital Dislocations in Adults: A Systematic Review. World Neurosurg. 2022; 162:e568-e579. DOI: 10.1016/j.wneu.2022.03.055. View

20.

Holy M, Szigethy L, Joelson A, Olerud C . A Novel Treatment of Pediatric Atlanto-Occipital Dislocation with Nonfusion Using Muscle-Preserving Temporary Internal Fixation of C0-C2: Case Series and Technical Note. J Neurol Surg Rep. 2023; 84(1):e11-e16. PMC: 9873479. DOI: 10.1055/s-0043-1760830. View