Atlanto-occipital dislocation

Abstract

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 essential to ensure timely recognition and treatment, thus preventing neurological decline or death. 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. However, despite overall improved outcomes, AOD is still associated with significant morbidity and mortality. 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.Hall GC, Kinsman MJ, Nazar RG, Hruska RT, Mansfield KJ, Boakye M, Rahme R. Atlanto-occipital dislocation. INTRODUCTIONIn a recent study of 300 patients with cervical spine trauma, 30% of injuries were located between the occiput and C2. Among these, acute spondylolysis of C2 (hangman's fracture), C1 ring fractures, odontoid fractures, and atlanto-occipital dislocation (AOD) were the most common [1] . Graham AbstractAtlanto-occipital dislocation (AOD) is being increasingly recognized as a potentially survivable injury as a result of improved prehospital management of polytrauma patients and increased awareness of this entity, leading to earlier diagnosis and more aggressive treatment. However, despite overall improved outcomes, AOD is still associated with significant morbidity and MINIREVIEWS 236March 18, 2015|Volume 6|Issue 2|

Association of Atlanto-Occipital Dislocation, Retroclival Hematoma, and Hydrocephalus: Management and Survival in a Pediatric Patient

“…The neurological injury may be a result of direct traction or compression of the spinal cord. The injury may also arise indirectly from vascular injury causing ischemia 1. Signs of AOD include headaches, ataxia, other motor or sensory neurological deficits, and respiratory distress 5.…”

“…However, AOD is becoming more of a survivable injury due to timely diagnosis and improved management of such injuries in the prehospital and hospital setting 1. Despite such improvements, AOD remains an injury with high morbidity and mortality, often due to early complications 2.…”

The atlanto-occipital joint: a concise review of its anatomy and injury

“…[5] The apical ligament ( Figure 6) joins the tip of the odontoid process to the basion (the most anterior point of the foramen magnum in the median sagittal plane) and has no mechanical role and is absent in 20% of the bodies studied by Tubbs et al [5] The AOJ allows 11-13° of freedom, allowing for 25° of flexion and extension, 5° of axial rotation, and combined motions. [7] Flexion is limited by the contact between the foramen magnum and the dens. [7] According to Tubbs et al, the tectorial membrane (TM) (Figure 6), a mean thickness of 1 mm, firmly attaches cranial base and body of the axis.…”

“…[7] Flexion is limited by the contact between the foramen magnum and the dens. [7] According to Tubbs et al, the tectorial membrane (TM) (Figure 6), a mean thickness of 1 mm, firmly attaches cranial base and body of the axis. [8] The TM stabilizes the head in flexion and extension of the neck.…”

Cadaveric study of movement in the unstable upper cervical spine during emergency management: tracheal intubation and cervical spine immobilisation—a study protocol for a prospective randomised crossover trial

“…The upper cervical spine injuries are frequently associated with significant neurological deficits and high mortality as a consequence of spinal cord injury or brainstem injury 3 4. Among these, the atlanto-occipital dislocation (AOD) is considered as the most fatal injury of the cervical spine,4–6 whereas C2 is the most frequent level of cervical spine injury 7–9. Furthermore, type II odontoid fracture is reported as the most frequent site of injury to C2 7.…”