Dual-strap augmentation of a halo orthosis in the treatment of atlantooccipital dislocation in infants and young children

Steinmetz, Michael P.; Verrees, Meg; Anderson, James S.; Lechner, Roseanna M.

doi:10.3171/spi.2002.96.3.0346

Cited by 12 publications

(11 citation statements)

References 22 publications

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“…Sixth nerve palsy is the most common cranial nerve injury. Another common cranial nerve palsy is the hypoglossal nerve [5,8,17,29,30]. Such neuropathy is probably induced by the sudden axial distraction on the nerves and medulla, or injury of cranial nerve nuclei [5,7,8,31].…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors in traumatic atlanto-occipital dislocation

Fard

Avila

Johnstone

et al. 2016

Journal of Clinical Neuroscience

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Section: Discussionmentioning

confidence: 99%

Prognostic factors in traumatic atlanto-occipital dislocation

Fard

Avila

Johnstone

et al. 2016

Journal of Clinical Neuroscience

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“…Conservative treatment with extension or halo-fixator as further management is recommended in children and in the case of little instability of AOD [2,28,49,56,63,73,83,84,93]; however, from the aforementioned literature it is not evident how much instability may be tolerated. In children, a fibrous ankylosis is expected after months of conservative treatment [49,56,83,93]. In adults and with increasing instability, a short dorsal spondylodesis should be performed [15,34,68,82,93].…”

Section: Discussionmentioning

confidence: 99%

Atlanto-occipital dislocation: four case reports of survival in adults and review of the literature

Labler

Eid

Platz

et al. 2004

European Spine Journal

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IntroductionFractures and dislocations of the cranio-cervical junction represent one-third of all injuries to the cervical spine. They are usually caused by high-energy trauma such as traffic accident or fall from a great height [3, 9]. Atlantooccipital dislocation (AOD), because of its accompanying injuries to the brain stem and lesions to the vascular structures of the neck, is mostly a lethal injury [11,32,98]. The diagnosis is often overlooked [74]. Recognition of AOD and therapeutic procedures are hampered by the frequent combination of AOD with traumatic brain injury and/or polytrauma. In this article four adult patients with AOD are presented and two showed a long-term survival and were surgically treated. Case reports Case 1A 22-year-old man fell 12 m from a roof, was unconscious and had a Glasgow Coma Scale (GCS) of three points for an unknown time. Cardiac arrest and apnea occurred after arrival of the rescue team. Following successful resuscitation and intubation, the patient was transferred to the emergency ward of the University Hospital of Zurich without relaxation or sedation. The GCS was unchanged, pupillary light reactions and vital signs were normal. Except for a generalized brain edema in the computed tomography (CT) scan of the head, there were no pathological findings in the clinical and radiological work-up. After insertion of a subdural catheter for intracranial pressure (ICP) monitoring, the patient was transferred to the intensive care unit (ICU). On the first posttraumatic day, clinical neurological examination showed bilateral cranial Abstract Traumatic atlanto-occipital dislocation (AOD) is a rare cervical spine injury and in most cases fatal. Consequently, relatively few case reports of adult patients surviving this injury appeared in the literature. We retrospectively report four patients who survived AOD injury and were treated at our institution. A young man fell from height and a woman was injured in a traffic accident. Both patients survived the injury but died later in the hospital. The third patient had a motorcycle accident and survived with incomplete paraplegia. The last patient, a man involved in a working accident, survived without neurological deficit of the upper extremities. Rigid posterior fixation and complete reduction of the dislocation were applied in last two cases using Cervifix together with a cancellous bone grafting. Previously reported cases of patients surviving AOD are reviewed, and clinical features and operative stabilisation procedures are discussed.

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“…20,21 Most investigators recommend a regime of conservative treatment with a halo frame in children, especially if there is little instability. 7,20,21,24 However, others think that these measures are insufficient and advocate immediate internal fixation. 4,5,19 It is suggested that halo immobilization alone is insufficient and can give a chronic unstable situation, eventually requiring operative fixation.…”

Section: Treatmentmentioning

confidence: 97%