J Korean Soc Spine Surg.  2009 Dec;16(4):285-289. 10.4184/jkss.2009.16.4.285.

Traumatic Atlanto-Occipital Dislocation: A Case Report

• Chung IK
• Lee KY
• Kim HJ
• Sun SK

• KMID: 1819810
• DOI: http://doi.org/10.4184/jkss.2009.16.4.285

Abstract

Survival after traumatic atlanto-occipital dislocation is rare. Severe persistent neurological deficits are common in the survivors, but early resuscitation and the use of the newer diagnostic techniques have contributed to improved outcomes. We present here the case of a 42 year old man with traumatic atlanto-occipital dislocation combined with a dens fracture, and the patient obtained good clinical results after we applied a Halo-vest and performed posterior fusion.

Keyword

Atlanto-occipital dislocation; Occipito-cervical fusion

MeSH Terms

Dislocations
Humans
Resuscitation
Survivors

Figure

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  Fig. 1. Radiologic measurements in occipito-cervical dislocation. A. Basion-axial interval: the distance between the posterior axial line and a parallel line drawn through the basion. B. Basion-dental interval: the distance from the caudad end of the basion to the rostral tip of the dens axis. C. Power's ratio (BC/OA): the quotient derived from the distance of the basion (B) to the posterior arch of C1(C), and the posterior aspect of the anterior arch of the atlas (A) to the opisthion (O).

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  Fig. 2. Initial lateral cervical spine radiograph and CT scan suggests atlanto-occipital dislocation. (A) Initial lateral roentgenographic view. (B, C) Axial CT scans. (D) Wackenheim's line. (E) Basion-axial and basion-dental interval. (F) Power's ratio.

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  Fig. 3. Sagittal and axial MRI shows high signal intensity in spinal cord.

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  Fig. 4. At 3 days after admission, Halo-vest application was done.

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  Fig. 5. Follow-up roentgenography and CT scans. (A, B) Anterior-posterior and lateral roentgenographic views at 3 months after Halo-vest Application. (C, D) Axial and sagittal CT scans at 3 months after Halo-vest application. (E, F) Anterior-posterior and lateral roentgenographic views after occipito-cervical fusion.

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