Occipito-atlantal dislocation (OAD) is a rare but often lethal type of spinal injury that can be found in up to 35% of traffic fatalities. Improved pre-hospital care, diagnosis, and immobilization of these patients have led to an increase in reported cases of survivors. Significant ligamentous disruption in OAD results in craniocervical instability. While the vast majority of patients will not survive, those who do present with a wide variety of neurological findings ranging from no deficit to quadriparesis with cranial nerve palsies. When the appropriate landmarks can be identified OAD can be identified on plain lateral cervical spine radiographs by using the basion-axial interval and basion-dental interval (or BAI-BDI) method. When this measurement is normal, but prevertebral soft tissue swelling is present, additional imaging such as magnetic resonance imaging and computerized tomography are useful to aid in making the diagnosis. Once this is established, immobilization followed by occipitocervical fusion is recommended. We present a case of a patient who survived for a brief period of time after being hit by a vehicle and who was found to have OAD. We discuss the pathophysiology, imaging, clinical findings, and treatment for this type of spinal injury.
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Neurosurg Rev
June 2021
Medical and Molecular Genetics, Indiana University Health Physicians, Indianapolis, IN, USA.
Atlanto-axial instability (AAI) is common in the connective tissue disorders, such as rheumatoid arthritis, and increasingly recognized in the heritable disorders of Stickler, Loeys-Dietz, Marfan, Morquio, and Ehlers-Danlos (EDS) syndromes, where it typically presents as a rotary subluxation due to incompetence of the alar ligament. This retrospective, IRB-approved study examines 20 subjects with Fielding type 1 rotary subluxation, characterized by anterior subluxation of the facet on one side, with a normal atlanto-dental interval. Subjects diagnosed with a heritable connective tissue disorder, and AAI had failed non-operative treatment and presented with severe headache, neck pain, and characteristic neurological findings.
View Article and Find Full Text PDFZ Orthop Unfall
October 2019
Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle (Saale).
In a consensus process with four sessions in 2017, the working group on "the upper cervical spine" of the German Society for Orthopaedic and Trauma Surgery (DGOU) formulated "Therapeutic Recommendations for the Diagnosis and Treatment of Fractures to the Upper Cervical Spine", incorporating their own experience and current literature. The following article describes the recommendations for the atlas vertebra. About 10% of all cervical spine injuries include the axis vertebra.
View Article and Find Full Text PDFNeurol Med Chir (Tokyo)
November 2011
Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
A 11-year-old female with Noonan syndrome presented with occipito-atlantal dislocation and upper cervical cord compression due to C1 dysplasia and basilar invagination. Computed tomography (CT) of the cervical spine showed dysplasia of the C1 posterior arch and bilateral dislocation of the occipito-atlantal joints. Dynamic lateral radiography revealed no instability at the occipito-atlantal joints.
View Article and Find Full Text PDFZhongguo Xiu Fu Chong Jian Wai Ke Za Zhi
May 2007
Department of Orthopaedics, the Second Affiliated Hospital, China Medical University, Shenyang Liaoning, 110004, P. R. China.
Objective: To explore the feasibilities, methods, outcomes and indications of atlas pedicle screw system fixation and fusion for the treatment of upper cervical diseases.
Methods: From October 2004 to January 2006, 17 patients with upper cervical diseases were treated with atlas pedicle screw system fixation and fusion. There were 13 males and 4 females, ageing 19 to 52 years.
Spine (Phila Pa 1976)
March 2007
Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
Study Design: Retrospective clinical and radiologic evaluation of posterior C1-C2 fusion by transarticular screw (TAS) with morselized autograft and without additional internal fixation.
Objective: Description and assessment of a modified Magerl technique.
Summary Of Background Data: The majority of spine surgeons prefer to supplement the posterior TAS with a posterior cable-secured strut graft and a postoperative rigid cervical orthosis.
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