Atlanto-Occipital Dislocation

Pang, Dachling; Nemzek, William R.; Zovickian, John

doi:10.1227/01.neu.0000290897.77448.1f

Cited by 101 publications

(32 citation statements)

References 22 publications

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“…Twenty-three patients (27%) had at least 1 recorded unilateral OC interval distance (Oc-C1), as initially described by Pang et al [2, 3], above the cut-off of 4 mm on either X-ray or CT, meaning that 73% of patients in the literature were fused according to other criteria. Notably, for 57 patients (66%), there was a formal review of cervical X-ray or CT describing OC injury, without explicit description of the Oc-C1 measurement.…”

Section: Resultsmentioning

confidence: 99%

“…Imaging-based characterization of the OCJ in children is largely based on the work of Pang et al [2, 3], which details both degrees of variation in the normal anatomy of the OC joint and the joint’s association with OCDI. While these studies have been instrumental in furthering the understanding of OCDI and have been incorporated into the guidelines adopted by the Joint Guidelines Committee American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS), this measurement alone is not comprehensive [17].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, some reports have questioned [1] whether the findings of Pang et al [2, 3] can be applied to all age groups. In addition, several studies [18] have found that the occipital condyle-C1 interval (CCI) measurement changes with age and that an enlarged CCI may not reach the cut-off value of 4 mm reported by Pang et al [2, 3] in cases of mild-to-moderate OCDI.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, several studies [18] have found that the occipital condyle-C1 interval (CCI) measurement changes with age and that an enlarged CCI may not reach the cut-off value of 4 mm reported by Pang et al [2, 3] in cases of mild-to-moderate OCDI. While this measurement may provide highly specific detection of frank AOD, it does not account for the wide spectrum of OCDI.…”

Section: Discussionmentioning

confidence: 99%

“…Pang et al [2, 3] describe both the normal anatomy and radiographic findings suggestive of OCDI, but it has been argued that these parameters cannot be applied to all age groups. Management decisions in pediatric OCDI are often based on expert opinion, and compared with operative series, there is a dearth of studies examining conservative methods to manage OCDI.…”

Section: Introductionmentioning

confidence: 99%

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Traumatic Occipitocervical Distraction Injuries in Children: A Systematic Review

et al. 2019

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Background: Occipitocervical distraction injuries (OCDI) in children occur on a wide spectrum of severity, and decisions about treatment suffer from a lack of rigorous guidelines and significant inter-institutional variability. While clear cases of frank atlanto-occipital dislocation (AOD) are treated with surgical stabilization, the approach for less severe cases of OCDI is not standardized. These patients require a careful assessment of both radiographic and clinical criteria, as part of a complex risk-benefit analysis, to establish whether occipitocervical fusion (OCF) is indicated. Here, we performed a systematic review of the literature that describes traumatic OCDI in children < 18 years of age. Summary: We performed a systematic review, according to PRISMA guidelines, of children < 18 years of age presenting with traumatic etiologies of OCDI. We searched PubMed to identify papers congruent with these criteria. Exclusion criteria included (1) reports on atraumatic causes of OCDI and (2) studies with insufficient clinical and radiographic details on individual patients. We identified 16 reports describing a total of 144 patients treated for pediatric traumatic OCDI. Based on the synthesis of these findings and the collective experience of the authors, we present the demographic, clinical, and radiographic factors that underlie OC instability, which we hope will serve as components of a grading system in the future. We considered various clinical and radiographic findings including: (1) the mechanism of injury, (2) the patient’s age, (3) CT/CT angiography of head and neck findings and parameters, (4) MRI findings, and (5) neurological exam, for the purpose of determining the severity of the OCDI and offering treatment guidelines based on the summative risk of underlying OC instability. Key Messages: OCDI is a potentially devastating injury, especially in children. Although missing the diagnosis can have potentially catastrophic consequences, reverting to surgical fixation in less severe cases can subject children to unnecessary operative risk and permanently reduce their range of motion. After reviewing all the available reports of pediatric traumatic OCDI in the neurosurgical literature, we propose an outline of clinical and radiographic factors influencing underlying OC instability that could be incorporated into a grading scale to guide treatment. We hope this study stimulates discussion on the standardization of treatment for pediatric OCDI.

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Section: Resultsmentioning

confidence: 99%