Prognostic factors in traumatic atlanto-occipital dislocation

Fard, Salman Abbasi; Avila, Mauricio J.; Johnstone, Cameron; Patel, Apar S.; Walter, C.; Skoch, Jesse; Sattarov, Kamran; Baaj, Ali A.

doi:10.1016/j.jocn.2016.05.021

Cited by 23 publications

(9 citation statements)

References 67 publications

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“…A corollary of the relationship between spine injury and mortality has been previously reported; in a review of studies examining patients with traumatic atlanto-occipital dislocation, only TBI was predictive of death. The presence of spinal cord injury, polytrauma, and severity of dislocation according to a classification system were not associated with mortality (28). Similarly, an examination of 10 years of trauma registry data from South Carolina also demonstrated TBI as an independent predictor of mortality in patients with spine injury, as did a retrospective review of 33 trauma patients from a single center in the Southwestern United States (29,30).…”

Section: Discussionmentioning

confidence: 99%

Presenting Characteristics Associated With Outcome in Children With Severe Traumatic Brain Injury: A Secondary Analysis From a Randomized, Controlled Trial of Therapeutic Hypothermia*

Rosario

Horvat

Wisniewski

et al. 2018

Pediatric Critical Care Medicine

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Severe traumatic brain injury is a clinically heterogeneous disease that can be accompanied by a range of neurologic impairment and a variety of injury patterns at presentation. This secondary analysis of prospectively collected data identifies several characteristics associated with outcome among children with severe traumatic brain injury. Future, larger trials are needed to better characterize phenotypes within this population.

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Section: Discussionmentioning

confidence: 99%

Presenting Characteristics Associated With Outcome in Children With Severe Traumatic Brain Injury: A Secondary Analysis From a Randomized, Controlled Trial of Therapeutic Hypothermia*

Rosario

Horvat

Wisniewski

et al. 2018

Pediatric Critical Care Medicine

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“…The literature describes traumatic OCD as a rare injury associated with patients sustaining high-energy trauma, such as motor vehicle collisions, pedestrian versus car accidents, or falls from great heights [6]. The mechanism of traumatic OCD is poorly defined but is always associated with sudden, high-energy deceleration forces resulting in hyperextension, hyperflexion, translation, and/or rotation of the upper cervical spine causing the ligamentous disruption [3, 5, 22–25]. Our case is unique in that it represents the first published case of a patient who sustained an OCD after low-energy trauma.…”

Section: Discussionmentioning

confidence: 99%

“…High-energy trauma produces hyperextension of the atlantooccipital joint (AOJ) [3], resulting in severe injury of the osseous and ligamentous complex that stabilizes the skull base to the spine [4]. The considerable force required to cause a traumatic OCD often results in concurrent injuries including the head, spinal cord, or other organ systems [5].…”

Section: Introductionmentioning

confidence: 99%

Occipitocervical Dislocation in Low-Energy Trauma

Tavolaro

Bransford

Yerrapragada

et al. 2018

Case Reports in Orthopedics

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Traumatic occipitocervical dislocation (OCD) is described in the literature as a potentially fatal injury secondary to high-energy trauma. We describe a case of OCD occurring in a patient who sustained a ground-level fall whose only clinical symptom was posterior neck pain without neurologic compromise. Computed tomography (CT) and magnetic resonance imaging (MRI) were used to diagnose severe injury to the structurally important ligamentous complex that stabilizes the base of the skull to the spine, along with unstable fractures of the occipital condyle and C1. Emergent surgical instrumentation and fusion of occiput-C2 was performed. Postoperatively, neurologic integrity was maintained. This case illustrates that traumatic OCD is not exclusively secondary to high-energy mechanisms. It also demonstrates that severe neck pain as the only clinical manifestation in a patient with head or neck low-energy trauma is suggestive of a possible OCD. We highlight the importance of the use of head and neck CT as the first imaging-based diagnostic tool to aid in identifying this injury. Finally, surgical stabilization should be performed as soon as possible to minimize neurologic sequelae.

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“…[28] Retrospective analyses of larger groups of patients with AOD have associated multiple factors portending worsened prognosis including delayed diagnosis, concomitant traumatic brain injury, lower GCS score, complete quadriplegia, the necessity of cardiopulmonary resuscitation, hypotension, older age, and suffering from other significant traumatic comorbidities. [1,4,7,8,18,23,24] In their small case series, Kimchi et al [16] found that patients with intact tectorial membranes have an improved prognosis. Recently, Fiester et al [9] proposed an MRI classification scheme for tectorial membrane injuries, which may empower MRI as a prognostic tool in carefully selected patients.…”

Section: Treatment Hospital Course and Post Hospital Follow-upmentioning

confidence: 99%

Successful non-operative management for atlanto-occipital dislocation resulting in spinal cord contusion in a patient with atlanto-occipital assimilation and severe Chiari I malformation

Davis

Kluckman

Mallory

et al. 2020

Surgical Neurology International

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Background: Atlanto-occipital dislocation (AOD) is a rare, highly morbid, and highly lethal injury that results from high-energy trauma and almost universally requires operative management for satisfactory outcomes. It can be difficult to identify the severity of injury at the time of presentation, and when diagnosis is delayed outcomes worsen significantly. Anatomic anomalies of the craniovertebral junction may further complicate its detection. When such anomalies are present either singly or in combination, they are known to cause space constraints which may increase the likelihood of spinal cord injury. Given that such anomalies and AOD are rare, few examples of patients with both are reported in the literature. Furthermore, it is not clear in what way patient management may be impacted in this context. Case Description: We will present a unique case of an 18-year-old patient with traumatic AOD and an intact neurologic examination who was found to have atlanto-occipital assimilation (AOA), platybasia, basilar invagination, and severe Chiari I malformation, who was treated effectively with non-operative management. Conclusion: Our case demonstrates the successful application of a non-operative treatment strategy in a carefully selected patient with AOD in the context of AOA.

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Prognostic factors in traumatic atlanto-occipital dislocation

Cited by 23 publications

References 67 publications

Presenting Characteristics Associated With Outcome in Children With Severe Traumatic Brain Injury: A Secondary Analysis From a Randomized, Controlled Trial of Therapeutic Hypothermia*

Presenting Characteristics Associated With Outcome in Children With Severe Traumatic Brain Injury: A Secondary Analysis From a Randomized, Controlled Trial of Therapeutic Hypothermia*

Occipitocervical Dislocation in Low-Energy Trauma

Successful non-operative management for atlanto-occipital dislocation resulting in spinal cord contusion in a patient with atlanto-occipital assimilation and severe Chiari I malformation

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