A Case of Asymptomatic Occipital Condyle Fracture with Incomplete Occipitocervical Dislocation: How Did It Happen?

Anania, Pasquale; Fiaschi, Pietro; Sbaffi, Pier Filippo; Zona, Gianluigi

doi:10.1016/j.wneu.2017.10.082

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…The clinical presentation of patients with traumatic OCD is extremely variable. However, we can divide patients into two broad groups: patients with severe neurological deficits and associated head, spinal cord, or multisystem trauma [4] and patients without neurological deficits who present with only severe neck pain, which represents up to 20% of those with an OCD [2, 6–9]. Our patient above belongs to the second group; the low-energy mechanism and the characteristically wide vertebral canal in the high cervical spine likely contributed to his lack of neurologic deficits.…”

Section: Discussionmentioning

confidence: 99%

“…The most common mechanism of OCD is sudden deceleration after high-energy trauma, such as in motor vehicle collisions, pedestrian versus automobile accidents, or falls from great heights. The incidence of OCD is 8% and represents around 20% of the fatal cervical spine injuries [2]. High-energy trauma produces hyperextension of the atlantooccipital joint (AOJ) [3], resulting in severe injury of the osseous and ligamentous complex that stabilizes the skull base to the spine [4].…”

Section: Introductionmentioning

confidence: 99%

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Occipitocervical Dislocation in Low-Energy Trauma

Tavolaro

Bransford

Yerrapragada

et al. 2018

Case Reports in Orthopedics

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Traumatic occipitocervical dislocation (OCD) is described in the literature as a potentially fatal injury secondary to high-energy trauma. We describe a case of OCD occurring in a patient who sustained a ground-level fall whose only clinical symptom was posterior neck pain without neurologic compromise. Computed tomography (CT) and magnetic resonance imaging (MRI) were used to diagnose severe injury to the structurally important ligamentous complex that stabilizes the base of the skull to the spine, along with unstable fractures of the occipital condyle and C1. Emergent surgical instrumentation and fusion of occiput-C2 was performed. Postoperatively, neurologic integrity was maintained. This case illustrates that traumatic OCD is not exclusively secondary to high-energy mechanisms. It also demonstrates that severe neck pain as the only clinical manifestation in a patient with head or neck low-energy trauma is suggestive of a possible OCD. We highlight the importance of the use of head and neck CT as the first imaging-based diagnostic tool to aid in identifying this injury. Finally, surgical stabilization should be performed as soon as possible to minimize neurologic sequelae.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Occipitocervical Dislocation in Low-Energy Trauma

Tavolaro

Bransford

Yerrapragada

et al. 2018

Case Reports in Orthopedics

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“…Traumatic occipitocervical dislocations (OCDs) are rare and potentially devastating injuries ( 1 ). Their prevalence is roughly 6–8%, and can represent up to 15-20% of fatal cervical spine injuries ( 2 ). They often result from sudden deceleration in high-energy trauma.…”

Section: Introductionmentioning

confidence: 99%

Non-operative treatment of atlanto-occipital incongruity following high energy trauma: a case report

Bunzel¹,

Khoo²,

Zhou³

2023

AME Case Rep

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Background Traumatic occipitocervical dislocations (OCDs) are rare and potentially devastating injuries, and delayed diagnosis and management is a well-known risk factor for poor outcomes in high energy trauma. Early surgical stabilization has been shown to improve outcomes and neurologic recovery in these patients. We present a case of incongruent atlanto-occipital (O-C1) joints found on post-operative computed tomography (CT) imaging following C1-C2 fusion. This patient was treated non-operatively in a cervical collar (C-collar) after traction testing revealed no dynamic instability. Case Description A 19-year-old male with history of obesity was involved in a high-speed motor vehicle collision (MVC). On arrival, he had elevated troponins but otherwise normal laboratory workup and electrocardiogram (EKG). He remained hypotensive throughout his initial presentation. A reliable neurologic exam could not be obtained due to the patient’s intubated and sedated status, however, bulbocavernosus reflex was intact, reflexes were normal and the patient did not demonstrate evidence of spinal or neurogenic shock. CT of the full spine revealed distraction of the C1-C2 articulation without associated fracture, and without clear disruption or distraction of the O-C1 joint. He was taken to the operating room for C1-C2 posterior instrumentation and fusion. Post-operative cervical spine CT revealed further distraction and subluxation of the occipitocervical junction bilaterally, with condyle to C1 interval (CCI) of 4-mm bilaterally, a basion-dens interval (BDI) of 10 mm, and a Power’s Ratio of 1.1. The patient was brought back urgently to the operating room for traction testing to rule out OCD. There was no distraction noted on dynamic traction testing, and the patient was treated non-operatively in a C-collar. At 12 weeks post-injury, the patient experienced no neck pain, and flexion/extension radiographs showed no evidence of subluxation or distraction at the O-C1 joints. Conclusions Incongruity of the O-C1 joint may not be synonymous with instability as previously thought, and in cases of O-C1 incongruity with stable traction testing, non-operative treatment with external immobilization can be considered as a viable treatment option even in the polytraumatized patient.

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Management of post-traumatic craniovertebral junction dislocation: A PRISMA-compliant systematic review and meta-analysis of casereports

2020

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Although historically considered fatal, with the advent of improved pre-hospital care, traumatic dislocation of the craniovertebral junction (CVJ) has been increasing in prevalence in neurosurgical centers. As more survivors are reported each year, a timely review with meta-analysis of their management seems necessary. PRISMA checklist was followed step by step. PubMed and Web of Science databases were searched using words “craniovertebral junction dislocation” and their corresponding synonyms. Study eligibility criteria included research studies from 2015 onwards that delineated adult and pediatric patients with confirmed post-traumatic atlantooccipital dislocation (AOD) or atlantoaxial dislocation (AAD) who survived until proper treatment. Of 1475 initial records, 46 articles met eligibility criteria with a total of 141 patients with traumatic CVJ dislocation. Of the patients, 90 were male (63.8%). Mean age of the cohort was 33.3 years (range 1–99 years). Trauma that most often led to this injury was road traffic accident (70.9%) followed by falls (24.6%). The majority of authors support posterior instrumentation of C1-C2 (45.2%) especially by means of Goel-Harms method. At mean follow-up of 15.4 months (range 0.5–60 months), 27.2% of treated patients remained neurologically intact. Of initially symptomatic, 59% improved, 37% were stable, and 4% deteriorated. Instrumenting the occiput in cases of pure AAD was associated with lower chance of neurological improvement in chi-square test (p = 0.0013) as well as in multiple linear regression (β = − 0.3; p = 0.023). The Goel-Harms C1-C2 fusion is currently the most frequently employed treatment. Many survivors remain with no deficits or improve, rarely deteriorate. Involving the occiput in stabilization in cases of AAD without AOD might be related with worse neurological prognosis.

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A Case of Asymptomatic Occipital Condyle Fracture with Incomplete Occipitocervical Dislocation: How Did It Happen?

Cited by 5 publications

References 22 publications

Occipitocervical Dislocation in Low-Energy Trauma

Occipitocervical Dislocation in Low-Energy Trauma

Non-operative treatment of atlanto-occipital incongruity following high energy trauma: a case report

Management of post-traumatic craniovertebral junction dislocation: A PRISMA-compliant systematic review and meta-analysis of casereports

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