Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects.

Harris, John H.; Carson, Gordon; Wagner, Louis K.

doi:10.2214/ajr.162.4.8141012

Cited by 240 publications

(141 citation statements)

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“…According to the latest guidelines for AOD published in 2013, 28 the basion axial interval-basion dental interval (BAI-BDI) method described by Harris et al 10 is the most reliable way of diagnosing AOD on lateral cervical radiographs. Because the BAI-BDI method has a sensitivity of only 50.5%, a large portion of patients will require additional confirmatory imaging.…”

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confidence: 99%

“…They reported that a normal CCI was 1.28 ± 0.26 mm and proposed a CCI ≥ 4 mm as diagnostic for AOD. They found the CCI to have a sensitivity and specificity of 100% compared with other standard diagnostic tests including the Powers 23 ratio, Wholey 31 method, Harris 10 BAI-BDI, and Sun 27 interspinous ratio. Several authors have suggested that in adults a CCI ≥ 2 mm is abnormal.…”

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confidence: 99%

“…Although a few studies address this topic, 28,30 to our knowledge, this paper presents the largest CT-based study evaluating normal and abnormal parameters for the CCI exclusively in the adult population. We report the CCI for 59 adults without AOD and for 22 adults with AOD and compare their results with published radiological diagnostic criteria 7,10,15,18,19,23,27,31 to determine whether a highly sensitive and specific cutoff value for diagnosing AOD with neuroimaging studies can be defined.…”

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Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle–C1 interval

Martinez-del-Campo

Kalb

Soriano-Baron

et al. 2016

SPI

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OBJECT Atlantooccipital dislocation (AOD) in adults cannot be diagnosed with adequate specificity and sensitivity using only CT or plain radiography, and the spine literature offers no guidelines. In children, the most sensitive and specific radiographic measurement for the diagnosis of AOD is the CT-based occipital condyle–C1 interval (CCI). The goal of the current study was to identify the normal CCI in healthy adults and compare it with the CCI in adults with AOD to establish a highly sensitive and specific cutoff value for the neuroimaging diagnosis of AOD. METHODS A total of 81 patients, 59 without AOD and 22 with AOD, were included in this study. Measurements obtained from thin-slice CT scans of the craniovertebral joint to assess atlantooccipital dislocation included the CCI, condylar sum, the Wholey and Harris intervals, Powers and Sun ratios, Wackenheim line, and Lee X-lines. RESULTS The group of patients without AOD included 30 men (50.8%) and 29 women (49.2%) with a mean age of 42.4 ± 16 years (range 19–87 years). The group of patients with AOD included 10 men (45.5%) and 12 women (54.5%) with a mean age of 38.2 ± 9.7 years (range 20–56 years). Interrater reliabilities within a 95% CI were all greater than 0.98 for CCI measurements. A total of 1296 measurements of the CCI were made in 81 patients. The mean CCI for non-AOD patients was 0.89 ± 0.12 mm, the single largest CCI measurement was 1.4 mm, and the largest mean for either right or left CCI was 1.2 mm. The mean condylar sum was 1.8 ± 0.2 mm, and the largest condylar sum value was 2.2 mm. Linear regression with age predicted an increase in CCI of 0.001 mm/year (p < 0.05). The mean CCI in AOD patients was 3.35 ± 0.18 mm (range 1.5 mm–6.4 mm). The shortest single CCI measurements in the AOD patients were 1.1 mm and 1.2 mm. The mean condylar sum for all 22 AOD patients was 6.7 ± 2.7 mm and the shortest condylar sums were 3.0 mm. Cutoff values for AOD were set at 1.5 mm for the CCI and 3.0 mm for the condylar sum, both with a sensitivity of 1 and false-negative rate of 0. Sensitivity for the Powers, Wholey, Harris, Sun, Wackenheim, and Lee criteria were determined to be 0.55, 0.46, 0.27, 0.23, 0.41, and 0.41, respectively. CONCLUSIONS The CCI is shorter in adult patients as opposed to the pediatric population. The revised CCI (1.5 mm) and condylar sum (3.0 mm) cutoff values have the highest sensitivity and specificity for the diagnosis of AOD in the adult population.

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confidence: 99%

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confidence: 99%

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Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle–C1 interval

Martinez-del-Campo

Kalb

Soriano-Baron

et al. 2016

SPI

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“…Typically,the tectorial membrane fails at or abovethe transverseatlantal ligament but may avulse its origin at the foramen magnum (â€oeringâ€• fracture) [4] Harris et al [6] developed criteria for defining thenormal occipitocervical junctiononcross-ta ble lateralradiographof the cervical spineusing readily made measurements. The distancebe tween the basion and the dens should be 12 mm or less, andtheposterior axiallineshouldbe no more than 12 mm posterior (95% ofcontrol sub jects) or 4 mm anteriorto the basion (Fig.…”

Section: Discussionmentioning

confidence: 99%

Rapid diagnosis and treatment of a traumatic atlantooccipital dissociation.

Deliganis

Mann²,

Grady³

1998

American Journal of Roentgenology

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“…Despite the availability of several, radiological and conventional evaluation procedures for the detection of AOD [6][7][8][9][10][11][12], it still remains unclear as to whether the injury per se or the severity of comorbid trauma leads to death.…”

Section: Introductionmentioning

confidence: 99%

Incidence and outcome of atlanto-occipital dissociation at a level 1 trauma centre: a prospective study of five cases within 5 years

et al. 2012

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Background Prospective evaluation of atlanto-occipital dissociations (AODs) at a level 1 trauma centre within 5 years. Methods Over a period of 5 years (2005)(2006)(2007)(2008)(2009), all CT scans of the skull base and the upper cervical spine due to traumatic injuries were prospectively entered into a database. Furthermore, in cases of confirmed AOD all empirical data were prospectively collected. A more detailed data analysis of all AOD patients was conducted 2 years post-trauma. If required, another prospective follow-up was performed. Results 2,616 CT scans were performed in total. Out of these, there were five male patients with confirmed AOD. Thus, the total incidence was 0.2 %. AOD was associated with occipital condyle fractures in three out of the five cases. Three out of five patients (60 %) died due to the severity of the injury. It was possible to stabilise two patients surgically with a clinical/radiological follow-up 2 years post-surgery. At that time, one patient had an incomplete tetraplegia and was wheelchair ridden without needing ventilation, while the other patient suffered from post-traumatic stress disorder, but was able to walk and live alone. Conclusions AOD is a rarely seen injury, even in a level 1 trauma centre, and is associated with high morbidity and mortality. However, it is possible for adults to survive this severe occipito-cervical injury after surgical repair while maintaining the ability to walk. All the results and recommendations are still based on a low level of evidence, due to the low incidence of this injury.

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Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects.

Cited by 240 publications

References 4 publications

Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle–C1 interval

Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle–C1 interval

Rapid diagnosis and treatment of a traumatic atlantooccipital dissociation.

Incidence and outcome of atlanto-occipital dissociation at a level 1 trauma centre: a prospective study of five cases within 5 years

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