Management of post-traumatic craniovertebral junction dislocation: A PRISMA-compliant systematic review and meta-analysis of casereports

Abstract

Although historically considered fatal, with the advent of improved pre-hospital care, traumatic dislocation of the craniovertebral junction (CVJ) has been increasing in prevalence in neurosurgical centers. As more survivors are reported each year, a timely review with meta-analysis of their management seems necessary. PRISMA checklist was followed step by step. PubMed and Web of Science databases were searched using words “craniovertebral junction dislocation” and their corresponding synonyms. Study eligibility criteria included research studies from 2015 onwards that delineated adult and pediatric patients with confirmed post-traumatic atlantooccipital dislocation (AOD) or atlantoaxial dislocation (AAD) who survived until proper treatment. Of 1475 initial records, 46 articles met eligibility criteria with a total of 141 patients with traumatic CVJ dislocation. Of the patients, 90 were male (63.8%). Mean age of the cohort was 33.3 years (range 1–99 years). Trauma that most often led to this injury was road traffic accident (70.9%) followed by falls (24.6%). The majority of authors support posterior instrumentation of C1-C2 (45.2%) especially by means of Goel-Harms method. At mean follow-up of 15.4 months (range 0.5–60 months), 27.2% of treated patients remained neurologically intact. Of initially symptomatic, 59% improved, 37% were stable, and 4% deteriorated. Instrumenting the occiput in cases of pure AAD was associated with lower chance of neurological improvement in chi-square test (p = 0.0013) as well as in multiple linear regression (β = − 0.3; p = 0.023). The Goel-Harms C1-C2 fusion is currently the most frequently employed treatment. Many survivors remain with no deficits or improve, rarely deteriorate. Involving the occiput in stabilization in cases of AAD without AOD might be related with worse neurological prognosis.

Fluoroscopy-Assisted C1–C2 Posterior Fixation for Atlantoaxial Instability: A Single-Center Case Series of 78 Patients

“…This study evaluated 78 consecutive cases of atlantoaxial instability treated with posterior C1-C2 fixation. The results are in accordance with previously published studies suggesting that non-navigated posterior C1-C2 fixation, with both TAS and SRC, is an effective treatment for cervical instability and pain [2][3][4][5][6]10,11,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Three patients (3.8%) underwent revision to improve construct stability, in 2 cases due to renewed trauma with extended posterior fixation (C0-C4 and C0-Th2) and in 1 case due to fractured TAS combined with neck pain, where the TAS-construct was removed in favor of SRC.…”

Meta-Analysis: The Influence of Knowledge, Education, and Husband's Support on The Selection of Long Acting Contraception Methods

“…Furthermore, screening is carried out by deleting duplicate journals, journals that do not focus on the topic, journals with qualitative methods, journals in languages other than Indonesian and English, and journals that are only abstract and cannot be accessed. The screening results from 4,018 journals were obtained as many as 77 journals, then assessed the feasibility of the journals with AMSTAR so that as many as 20 journals were selected with high quality (score [9][10][11].…”

Prevalence of high-riding vertebral arteries and narrow C2 pedicles among Central-European population: a computed tomography-based study

“…As it was recently noted, the most commonly employed method of managing both post-traumatic and rheumatic craniovertebral dislocation is Goel-Harms C1 lateral mass-C2 pedicle screw placement [6,7]. This procedure has become a gold standard thanks to polyaxial screws that provide a solid bicortical purchase.…”