Clinical and Radiological Clues of Traumatic Craniocervical Junction Injuries Requiring Occipitocervical Fusion to Early Diagnosis

Abstract

Objective: The purpose of this study is to find the clinical and radiographic characteristics of traumatic craniocervical junction (CCJ) injuries requiring occipitocervical fusion (OC fusion) for early diagnosis and surgical intervention.Methods: We retrospectively reviewed 12 patients with CCJ injuries presenting to St. Michaels Hospital in Toronto who underwent OC fusion and looked into the following variables; (1) initial trauma data on emergency room arrival, (2) associated injuries, (3) imaging characteristics of computed tomography (CT) scan and magnetic resonance imaging (MRI), (4) surgical procedures, surgical complications, and neurological outcome.Results: All patients were treated as acute spinal injuries and underwent OC fusion on an emergency basis. Patients consisted of 10 males and 2 females with an average age of 47 years (range, 18–82 years). All patients sustained high-energy injuries. Three patients out of 6 patients with normal BAI (basion-axial interval) and BDI (basion-dens interval) values showed visible CCJ injuries on CT scans. However, the remaining 3 patients had no clear evidence of occipitoatlantal instability on CT scans. MRI clearly described several findings indicating occipitoatlantal instability. The 8 patients with normal values of ADI (atlantodens interval interval) demonstrated atlantoaxial instability on CT scan, however, all MRI more clearly and reliably demonstrated C1/2 facet injury and/or cruciate ligament injury.Conclusion: We advocate measures to help recognize CCJ injury at an early stage in the present study. Occipitoatlantal instability needs to be carefully investigated on MRI in addition to CT scan with special attention to facet joint and ligament integrity.

Traumatic atlanto‐occipital dislocation with successfully bystander resuscitation after cardiopulmonary arrest: A case report

“…Brain injury, altered level of consciousness, and multiple traumas complicate the diagnostic process and lead to missed AOD cases at the time of initial evaluation 1 . Therefore, relevant head and facial wounds and clinical clues (high‐energy trauma and loss of consciousness) are of paramount importance for the correct initial diagnosis of AOD 1,3 …”

“…In recent years, the initial diagnosis has shifted from radiography to standardized trauma whole‐body CT. Moreover, the increased awareness of AOD and standardization of measurement techniques of AOD have reduced the time to diagnosis 3,21 . On the contrary, some reports have highlighted cases of trauma patients with AOD diagnosed using MRI, even when CT scans are normal or close to normal 21,22 .…”

“…1 Therefore, relevant head and facial wounds and clinical clues (high-energy trauma and loss of consciousness) are of paramount importance for the correct initial diagnosis of AOD. 1,3 Table 1 includes a full list of pearls and pitfalls of AOD diagnosis and treatment. Regarding diagnostic imaging, the systematic and historical diagnosis of AOD was described by Powers et al based on radiography.…”

“…Furthermore, AOD has been problematic because of its delayed diagnosis and high fatality rate. [1][2][3] We report a case of successful bystander cardiopulmonary resuscitation (CPR) after CPA due to a traffic accident, followed by early diagnosis and treatment of AOD, leading to successful reintegration into the community.…”

“…Traumatic atlanto‐occipital dislocation (AOD) is a high‐energy injury in which the skull base and cranium separate, with serious complications, including traumatic brain and spinal cord injury, multiple organ damage, shock, and cardiopulmonary arrest (CPA). Furthermore, AOD has been problematic because of its delayed diagnosis and high fatality rate 1–3 . We report a case of successful bystander cardiopulmonary resuscitation (CPR) after CPA due to a traffic accident, followed by early diagnosis and treatment of AOD, leading to successful reintegration into the community.…”