Traumatic Occipito-Atlantal Dislocation

Evarts, Charles M.

doi:10.2106/00004623-197052080-00017

Cited by 96 publications

(32 citation statements)

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“…A secção dos ligamentos alares e da membrana tectória permite o deslocamento anterior do crânio com relação à coluna vertebral. É necessária a ruptura completa de todas as estruturas ligamentares entre o occipício e o complexo atlanto-axial para que ocorra a LTAO (14) . Os ligamentos alares estão mais distendidos e, conseqüente-mente, mais vulneráveis à lesão, quando a cabeça está rodada e, adicionalmente, fletida (15) .…”

Section: Discussionunclassified

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Luxação traumática atlanto-occipital: relato de caso

Defino¹,

Porto²,

Herrero³

et al. 2008

Rev. bras. ortop.

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INTRODUÇÃOO primeiro relato da luxação traumática atlanto-occipital (LTAO) ocorreu em 1908, no qual um marinheiro de 19 anos de idade sofreu acidente durante a prática de exercícios de ginástica (1) . O paciente, que apresentava quadriplegia completa e insuficiência respirató-ria, foi a óbito após ser submetido a laminectomia descompressiva.A luxação traumática atlanto-occipital é lesão rara e sua incidência exata permanece desconhecida. Nas vítimas fatais de acidente automobilístico foi observada incidência de 20-25% de LTAO, documentada por exames radiográficos (2) . Em nosso meio, não verificamos na literatura pertinente relatos desse tipo de lesão.Os pacientes que sobrevivem a essa lesão apresentam quadro clínico variado que não se correlaciona com o tipo da lesão atlanto-occipital. Os sintomas incluem dor cervical associada à limitação da mobilidade, torcicolo, paralisia dos nervos cranianos, sinais e sintomas sistêmicos de isquemia da circulação vertebrobasilar, déficit neurológico e coma (3)(4) . Os sobreviventes com ausência completa de lesão neurológica são raros (4) . RESUMOA luxação traumática atlanto-occipital é lesão rara, de incidência desconhecida e está associada a elevada taxa de mortalidade. Os autores relatam o diagnóstico, tratamento e seguimento de dois anos de uma paciente de 25 anos de idade, vítima de acidente automobilístico e luxação atlanto-occipital traumática confirmada por exames de imagem.Descritores -Articulação atlanto-occipital /lesões; Traumatismos da coluna vertebral / diagnóstico; Traumatismos da coluna vertebral / cirurgia; Relato de casos [Tipo de publicação] ABSTRACTTraumatic atlanto-occipital dislocation is a rare lesion whose incidence is not know, and which is

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Section: Discussionunclassified

“…Foram descritas relações entre as referências anatômicas da transição occipitocervical para o diagnóstico das lesões desse segmento vertebral. A linha de Wackenheim estende-se distalmente ao longo da superfície posterior do clivo (14) . Essa linha deveria tangenciar a ponta do odontóide.…”

Section: Discussionunclassified

Luxação traumática atlanto-occipital: relato de caso

Defino¹,

Porto²,

Herrero³

et al. 2008

Rev. bras. ortop.

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“…Associated injury to the vertebral arteries may lead to vascular compromise and secondary neurological deficit. 5,13,14 In one patient (case 1) the transient left-sided weakness associated with rotation of the neck may have been caused by kinking of the vertebral artery at the craniocervical junction. Magnetic resonance angiography was not undertaken due to the presence of stainless steel implants.…”

Section: Discussionmentioning

confidence: 99%

Traumatic dislocation of the atlanto-occipital joint

Govender

Vlok

Fisher-Jeffes³

et al. 2003

The Journal of Bone and Joint Surgery. British volume

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e present four patients who had sustained a traumatic dislocation of the atlanto-occipital joint. The diagnosis was initially missed in two patients. One patient, who was neurologically intact, was treated nonoperatively. The remaining three recovered neurologically after an occipitocervical fusion. Early recognition of the injury, especially in multiply-injured patients with head injuries, and timely management may improve survival and neurological recovery.J Bone Joint Surg [Br] 2003;85-B:875-8.

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“…hyperextension with traction and rotation [3,[5][6][7][8][9] combined with a cranio-facial injury [6,11]. Stability of the atlanto-occipital and atlantoaxial segments is maintained by a complex ligamentous system [4], including two separate components, namely: a central, intraspinal, occipito-axial component and a peripheral atlanto-occipital component.…”

Section: Discussionmentioning

confidence: 99%

Vertical atlantoaxial dislocation

Ramaré¹,

Lazennec²,

Camelot³

et al. 1999

European Spine Journal

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Dislocations of the first two cervical vertebrae are rare and very often fatal. We report a case of vertical atlantoaxial dislocation with no neurological signs and with a favourable outcome.A 62-year-old man was driving his car with his seat belt fastened when he had a violent head-on collision with a farming machine at the level of the plough. Axial traction responsible for hyperextension of the cervical spine and stretching of the left brachial plexus occurred. On arrival at the emergency unit, he had respiratory distress and blood aspiration due to a facial trauma. The Glasgow score was 3 and a CT scan of the brain showed mild intraventricular bleeding on the right.Plain radiographs of the cervical spine disclosed isolated C1-C2 dislocation, with a vertical C1-C2 gap exceeding 20 mm (Fig. 1). An emergency arteriogram of the aortic arch showed no abnormalities (Fig. 2).Immediate external reduction was carried out by applying firm pressure along the axis of the head under fluoroscopy (Fig. 3). Post-reduction stability was assessed during small flexion-extension motions.Tracheotomy and reconstructive maxillofacial surgery were immediately carried out, allowing secondary spinal stabilisation using a posterior approach in the prone position. Traumatic dura mater tears were identified and treated by biological glue. Posterior atlantoaxial fixation was performed using a combination of atlantoaxial grafting and wiring.Temporary fixation using an occipital-C4 plate (Howmedica) was performed (Fig. 4) to reduce the need for external immobilisation (cervical brace only). On day 9, an infection secondary to an occipital pressure sore was diagnosed. Microbiological studies of cerebrospinal fluid obtained by lumbar puncture were negative. On day 11, a revision was performed, but the fixation material was left in place.The patient was discharged from the intensive care unit after 3 months. He was still on antibiotic therapy, but had no tracheotomy or evidence of local infection. He had a persistent neurological deficit in the left upper limb, shown by electromyography to be secondary to the brachial plexus stretching. There was no evidence of spinal cord injury.One year later, the occipito-cervical plates were removed. Range of motion in all planes was excellent and the patient was fully pain free. The residual neurological deficit in the left upper limb was very mild (muscle score at 4+). DiscussionWe found no similar case of vertical atlantoaxial dislocation in the literature [2,10]. Furthermore, our clinical case calls for comments regarding three important points, namely:1. Interpretation of the lesion-inducing process 2. Patient status and absence of medulla oblongata or spinal cord neurological signs 3. Surgical strategy Abstract An unusual case of vertical atlantoaxial dislocation without medulla oblongata or spinal cord injury is reported. The pathogenic process suggested occipito-axial dislocation. The case was treated surgically with excellent results on mobility and pain.

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Traumatic Occipito-Atlantal Dislocation

Cited by 96 publications

References 0 publications

Luxação traumática atlanto-occipital: relato de caso

Luxação traumática atlanto-occipital: relato de caso

Traumatic dislocation of the atlanto-occipital joint

Vertical atlantoaxial dislocation

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