Complete medulla/cervical spinal cord transection after atlanto-occipital dislocation: An extraordinary case

Abstract

Study design: Case report. Summary of background data: Traumatic atlanto-occipital dislocation (AOD) with a complete medulla/spinal cord transection is rare and believed to be fatal owing to the high level of the spinal cord injury. Clinical outcome is poor. Consequently, relatively few case reports of adult patients surviving this injury appear in the literature. Objectives and result: We present the case of a 20-year-old male, who sustained an AOD with a complete medulla/spinal cord transection in a motorcycle accident to discuss the possibility of long-term survival with this condition. The patient underwent occipito-cervical stabilization. With an Injury Severity Score of 75, by definition unsurvivable, the patient is 16 months after the injury, ventilated and fully dependent for all care. Conclusion: Long-term survival following AOD with a complete medulla/spinal cord transection is possible if immediate resuscitation at the scene is available. Nevertheless, it remains questionable whether or not a patient with such a devastating injury and without any prospect of functional recovery should be kept alive under all circumstances.

Utility of post mortem computed tomography in clivus fracture diagnosis. Case illustration and literature review

“…In trauma center the localization of the head injuries, according with witnessed evidence, suggested a huge impact with subsequent violent anterior flexion of the victim neck may cause fractures of the clival region. These findings may reflect different mechanism of injury, whereby displaced fractures have a higher propensity for injury due to rotational force, causing ligamentous failure and chip-ping of the clivus while sparing surrounding structure [3].…”

“…Clivus fractures may be observed in a serious head blunt trauma due to traffic accidents and falls and the mortality rate and/or poor prognosis of the survivors is mainly due to concomitant injuries of the brainstem [3][4][5][6][7][8], lower cranial nerves [1,9,10] and vertebro-basilar artery [1,[11][12][13][14].…”

Actual concepts of classification, diagnosis and treatment of atlanto-occipital dislocations in adults: non-systematic literature review

“…Только иммобилизацию ортезом изначально применяли у 12 пациентов [5,[28][29][30][31][32][33][34][35][36], а у 3 пациентов иммобилизацию осуществляли как первый этап перед хирургическим лечением. Из 12 пациентов 5 умерли в первые 90 сут, 4 были с улучшением без оперативного вмешательства, 3, несмотря на проведенное хирургическое лечение, без изменений.…”

Cervical spinal cord injuries associated with resuscitation from fatal circulatory collapse

“…Thus it is worthwhile to investigate the characteristics of severe cervical spinal cord injury in a state of coma. Recently, there have been some reports of survival among SCI patients after resuscitation from cardiac arrest . Advances in pre‐hospital emergency systems, trauma protocols, and diagnostic imaging tools are largely responsible for these improved outcomes .…”