Traumatic dislocation of the atlanto-occipital joint

Govender, S.; Vlok, G. J.; Fisher-Jeffes, Norman; Preez, C. P. Du

doi:10.1302/0301-620x.85b6.14092

Cited by 38 publications

(37 citation statements)

References 17 publications

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“…9,28,29,72) Traumatic injuries to the atlantooccipital joint, such as occipital condyle fractures or atlantooccipital dislocation, are usually associated with more extensive ligamentous damage and instability than the isolated odontoid fracture. 25) Although isolated unilateral occipital condyle fracture can be treated conservatively, 35) patients with bilateral occipital condyle fractures or survivors of atlantooccipital dislocation will require rigid and long segmental fixation, i.e., occipitocervical fixation. 25,75,79,83) Recently, a new posterior transarticular screw fixation technique for atlantooccipital dislocation has been reported, with favorable results found in both a biomechanical study 24) and in a few clinical cases.…”

Section: Traumaticmentioning

confidence: 99%

“…25) Although isolated unilateral occipital condyle fracture can be treated conservatively, 35) patients with bilateral occipital condyle fractures or survivors of atlantooccipital dislocation will require rigid and long segmental fixation, i.e., occipitocervical fixation. 25,75,79,83) Recently, a new posterior transarticular screw fixation technique for atlantooccipital dislocation has been reported, with favorable results found in both a biomechanical study 24) and in a few clinical cases. 26) This technique will preserve the rotatory motion of the atlantoaxial joint, which is inevitably abolished by occipitocervical fixation.…”

Section: Traumaticmentioning

confidence: 99%

See 1 more Smart Citation

Posterior Instrumentation Surgery for Craniocervical Junction Instabilities: an Update

Inamasu

Kim

Klugh

2005

Neurol. Med. Chir.(Tokyo)

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The surgical treatment of craniocervical junction (CCJ) instability has recently undergone significant development and change. Posterior instrumentation surgery has been the mainstay of treatment of CCJ instability, and is the focus of this review. For the treatment of atlantoaxial instability, C1-2 transarticular screw fixation has shown good stability, and has been regarded as the``gold standard'' procedure. Because of potentially hazardous complications including vertebral artery injury, however, C-1 lateral mass-C-2 pedicle screw fixation is gaining popularity. For treatment of atlantooccipital instability, occipitocervical fixation using screw constructs (combined with either rods or plates) has shown more stability than sublaminar wiring techniques, and has been utilized more frequently. Both innovation in material engineering and in vitro biomechanical studies have contributed significantly to the development of more rigid internal fixation devices, and as a result, many patients who would have been treated conservatively with external orthosis are treated nowadays with instrumentation surgery, resulting in earlier ambulation, shortened hospital stay, and earlier recovery into social activities. New surgical techniques and instruments, however, need to stand the test of time to see whether they are free from long-term adverse events. The rapid turnover of new surgical techniques and hardware has made it difficult for less experienced surgeons to keep up with the latest developments. Conventional techniques can be safer and less technically demanding than newer techniques for those who are not familiar with them.

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Section: Traumaticmentioning

confidence: 99%

Section: Traumaticmentioning

confidence: 99%

Posterior Instrumentation Surgery for Craniocervical Junction Instabilities: an Update

Inamasu

Kim

Klugh

2005

Neurol. Med. Chir.(Tokyo)

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“…Furthermore, the methods used for the diagnosis of AOD have not been specified, even in current studies [15,16]. With our prospectively designed study in a level 1 trauma centre (for the first time in the literature), all CT scans performed during a 5-year period-including cranial, cervical, and polytrauma CT scans-were primarily analysed and recorded with regard to existing AOD and occipital condyle fractures.…”

Section: Discussionmentioning

confidence: 99%

“…The small number of cases explains the different treatment recommendations without any evidence, ranging from conservative therapy (distraction only) with neck support and Halo fixator to different cranio-cervical decompression and fusion methods [11,[14][15][16][17][18][19][20].…”

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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“…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.…”

Section: Epidemiologymentioning

confidence: 99%

Traumatic Atlantooccipital Dislocation

et al. 2006

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Traumatic atlantooccipital dislocation (AOD) is a severe injury which functionally separates the head from the spine. Neurological compromise or death is the common sequela. We report on a survivor after AOD, who came back to sportive activities after operative stabilization C0-2. Actually, due to the lack of large single institution series, there are no clearly recommended guidelines concerning diagnostics and treatment of AOD. Overlooking a critical review of literature, the inferences of our case are illustrated and diagnostic as well as operative treatment concepts are discussed.

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Traumatic dislocation of the atlanto-occipital joint

Cited by 38 publications

References 17 publications

Posterior Instrumentation Surgery for Craniocervical Junction Instabilities: an Update

Posterior Instrumentation Surgery for Craniocervical Junction Instabilities: an Update

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

Traumatic Atlantooccipital Dislocation

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