Diagnostik und Therapie der Verletzungen der oberen Halswirbelsäule

Traumatic Atlantooccipital Dislocation

“…The incidence of AOD was estimated to about 1-3% of all survivors of cervical spine injuries (CSI) [1], whereas Kortmann et al [25] in a level 1 trauma center detected only three in 10 years, as we did. The AOD is a seldom injury as numerous patients with severest discoligamentous injuries to the upper cervical spine die at scene because of brain stem lesion, transection of cervical spine cord or associated multiple injuries [2,4].…”

“…Due to an increasing efficiency of onscene resuscitation and modern diagnostics, the surgeon should expect being faced to diagnose and treat these seldom injuries more often [1,2,11,17]. In most of the cases patients as driver or passerby suffered AOD following a high-velocity injury as result of motor vehicle accidents [1,3,8,14,[16][17][18][25][26][27][28]. As a result of a maximum impact to the upper cervical spine one also has to expect further CSI associated with AOD.…”

“…In a comprehensive review of literature Labler et al [3] (n=79) found that in 19 of 50 (38%) children and in 17 of 29 (59%) adults the diagnosis of AOD, particularly of longitudinal instability, was delayed. Therefore, it is important to figure out pathologic markers which can arouse suspicion of AOD, such as severe head trauma, neurological abnormalities, particularly cranial nerve palsies as abducens paresis [8,25], upper cord or brain stem lesions leading to respiratory dysfunction, arrest or asystole onscene, and in all a low GCS [1-3, 8, 14, 17, 18, 25, 27, 28, 32]. It is rare having no clinical signs [16,26].…”

“…As the method of Harris is not influenced by flexion, extension and angulation, it is a recommended tool [18,25,29]. Related to magnification factors, variation in the position of the neck, identification of bony landmarks, which has its difficulties in children because of incomplete ossifications [15], and concomitant injuries of the atlas and axis, the study of OCJ by plain X-rays has several limitations [25,27,30]. X-rays are only a snapshot of discoligamentous instability of the cervical spine.…”

“…X-rays are only a snapshot of discoligamentous instability of the cervical spine. Dependent on positioning of the patient a less common posterior Harris-type III can be masked as slightly anterior dislocated type I lesion [25,28,29]. Moreover, in the case of posterior or longitudinal disclocations Power's ratio (Basion -posterior atlas arch, ophistion -anterior atlas arch) can be measured < 1, within normal limits [2-4, 16, 28, 29].…”