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Grin A, Lvov I, Talypov A, Kordonskiy A, Godkov I, Khushnazarov U, Krylov V. Factors affecting the outcomes of traumatic atlanto-occipital dislocations in adults: a systematic review. World Neurosurg 2022; 162:e568-e579. [DOI: 10.1016/j.wneu.2022.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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A Novel Reconstruction Using a Combined Anterior and Posterior Approach After Axis Tumor Spondylectomy. Clin Spine Surg 2020; 33:E299-E306. [PMID: 32604195 DOI: 10.1097/bsd.0000000000001039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE To describe a novel reconstruction strategy using a T-shaped titanium mesh cage with posterior cervical screw-rod fixation after total spondylectomy of axis tumors. SUMMARY OF BACKGROUND DATA Instability of the upper cervical spine because of tumors in axis (C2) often results in devastating complications. Surgical resection and reconstruction after spondylectomy of C2 remain a technical challenge because of the intricate anatomies, vital adjacent tissues, and the unique spinal biomechanics in this special region. MATERIALS AND METHODS The novel reconstruction mode included the construction of the anterior aspect conducted with a specially made titanium mesh cage and the posterior cervical fixation only. Patients who received total C2 tumors spondylectomy and reconstruction with this novel mode in our center between January 2009 and December 2017 were retrospectively analyzed to evaluate the efficacy of this novel reconstruction method. RESULTS A total of 24 patients with C2 tumor received total spondylectomy and the new mode of local reconstruction. The neurological deficits recovered well and local pain relieved significantly (P<0.001) during the mean follow-up time of 22 months. Perioperative complications were rare and controllable. No internal fixation failure occurred. The mobility of the occipital-cervical junction was largely preserved in all patients. CONCLUSIONS This novel reconstruction mode using an anterior "T-shaped" mesh cage with posterior screw-rod fixation provides satisfactory stability and motion of occipital-cervical junction with limited complications, and therefore may prove to be an ideal option for management of C2 tumors. LEVEL OF EVIDENCE Level IV.
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Occipitocervical Dislocation in Low-Energy Trauma. Case Rep Orthop 2018; 2018:3931525. [PMID: 30631620 PMCID: PMC6304856 DOI: 10.1155/2018/3931525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/19/2018] [Indexed: 11/18/2022] Open
Abstract
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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Anania P, Fiaschi P, Sbaffi PF, Zona G. A Case of Asymptomatic Occipital Condyle Fracture with Incomplete Occipitocervical Dislocation: How Did It Happen? World Neurosurg 2017; 109:403-408. [PMID: 29081394 DOI: 10.1016/j.wneu.2017.10.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/13/2017] [Accepted: 10/14/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Atlanto-occipital dislocation (AOD) is a lesion rarely observed in a trauma center, because of high mortality in the preclinical phase. The number of AOD survivors is increasing thanks to the improvement in prehospital resuscitation. CASE DESCRIPTION Our goal is to describe a case of incomplete atlanto-occipital dislocation presented without any neurologic, cardiorespiratory, or metabolic problems, which remained constant even after surgical treatment. Our purpose is also to discuss treatment approaches to minimize subsequent neurologic deficits. CONCLUSIONS We recommend a rapid immobilization with spine table and cervical collar, the consensual stabilization of hemodynamic and respiratory parameters, and a successive prompt occipitocervical stabilization. C2 should be included in the stabilization because of the ligamentous conformation of craniocervical joint.
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Affiliation(s)
- Pasquale Anania
- Department of Neurosurgery, San Martino-IST University Hospital, University of Genoa, Genoa, Italy
| | - Pietro Fiaschi
- Department of Neurosurgery, San Martino-IST University Hospital, University of Genoa, Genoa, Italy.
| | - Pier Filippo Sbaffi
- Department of Neurosurgery, San Martino-IST University Hospital, University of Genoa, Genoa, Italy
| | - Gianluigi Zona
- Department of Neurosurgery, San Martino-IST University Hospital, University of Genoa, Genoa, Italy
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Fard SA, Avila MJ, Johnstone CM, Patel AS, Walter CM, Skoch J, Sattarov KV, Baaj AA. Prognostic factors in traumatic atlanto-occipital dislocation. J Clin Neurosci 2016; 33:63-68. [PMID: 27554925 DOI: 10.1016/j.jocn.2016.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/05/2016] [Indexed: 12/19/2022]
Abstract
Traumatic atlanto-occipital dislocation (AOD) is an ominous injury with high mortality and morbidity in trauma patients. Improved survival has been observed with advancements in pre-hospital and hospital care. Furthermore, high quality imaging studies are accessible at most trauma centers; these are crucial for prompt diagnosis of AOD. The objective of this study is to perform a comprehensive literature review of traumatic AOD, with specific emphasis on identifying prognostic factors for survival. A review of the literature was performed using the Medline database for all traumatic atlanto-occipital articles published between March 1959 and June 2015; 141 patients from 60 total studies met eligibility criteria for study inclusion. A binary logistic regression model was utilized to identify prognostic factors. The analysis assessed age, sex, spinal cord injury (SCI), traumatic brain injury (TBI), polytrauma injury (PI), and Traynelis AOD Classification. Only TBI was statistically significantly associated with death (OR 8.05 p<0.05); SCI did not reach statistical significance for predicting mortality in AOD patients (OR 1.25 p>0.05). Age, sex, PI, and Traynelis AOD Classification did not meet significance to predict mortality in AOD patients. We found that patients with TBI are eight times more likely to die than patients without TBI. A high degree of suspicion for AOD during pre-hospital care, as well as, prompt diagnosis and management in the trauma center play a key role in the treatment of this devastating injury. The relationship between survival and factors such as TBI and SCI should be further explored.
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Affiliation(s)
- Salman Abbasi Fard
- Division of Neurosurgery, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Mauricio J Avila
- Weill Cornell Brain and Spine Center, 525 East 68 Street, Box 99, New York, NY 10065, USA.
| | - Cameron M Johnstone
- Division of Neurosurgery, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Apar S Patel
- Division of Neurosurgery, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Christina M Walter
- Division of Neurosurgery, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Jesse Skoch
- Division of Neurosurgery, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Kamran V Sattarov
- Division of Neurosurgery, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724, USA
| | - Ali A Baaj
- Weill Cornell Brain and Spine Center, 525 East 68 Street, Box 99, New York, NY 10065, USA
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Theodore N, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, Ryken TC, Walters BC, Hadley MN. The diagnosis and management of traumatic atlanto-occipital dislocation injuries. Neurosurgery 2013; 72 Suppl 2:114-26. [PMID: 23417184 DOI: 10.1227/neu.0b013e31827765e0] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Nicholas Theodore
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
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Smith KM, Yoganandan N, Pintar FA, Kurpad SN, Maiman DJ. Atlantooccipital dislocation in motor vehicle side impact, derivation of the mechanism of injury, and implications for early diagnosis. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2011; 1:113-7. [PMID: 21572632 PMCID: PMC3075827 DOI: 10.4103/0974-8237.77675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Numerous reports of atlantooccipital dislocations (AODs) have been described in frontal impacts and vehicle versus pedestrian collisions. Reports of survival after AOD in conjunction with side impacts have infrequently been reported in the literature. The objective of this study is to present a case of an AOD from a side impact vehicle collision, and deduce the mechanism of injury. A clinical and biomechanical reconstruction of the collision was performed to investigate the mechanism of the dislocation. A 51-year-old female was traveling in a four-door sedan and sustained a side impact collision with a compact pickup truck. At the time of extrication, the patient was neurologically intact with a Glasgow Coma Scale score of 15. After admittance to the hospital, the patient developed a decline in respiratory status, right mild hemiparesis, and left sixth-nerve palsy, and magnetic resonance imaging (MRI) and computed tomography (CT) reconstructions indicated a craniocervical dislocation. Surgical fixation was performed and all extra-axial hemorrhaging was evacuated. At discharge, the patient was neurologically intact on the left side, had right mild hemiparesis, left sixth-nerve palsy, and minor dysarthria. Survival rates of AODs have recently been increasing. Morbidity is still more prevalent, however. Due to the variety of symptoms that accompany AODs and the inconsistency of diagnostic imaging techniques, a thorough history of the etiology may lead to increased clinical suspicion of this injury and further raise survival rates.
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Affiliation(s)
- Kevin M Smith
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Lador R, Ben-Galim PJ, Weiner BK, Hipp JA. The association of occipitocervical dissociation and death as a result of blunt trauma. Spine J 2010; 10:1128-32. [PMID: 21094473 DOI: 10.1016/j.spinee.2010.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 09/13/2010] [Accepted: 09/30/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Despite multiple reports of survivability, dissociative occipitocervical injury (OCI) is generally accepted to be fatal in most cases. The actual number of trauma victims where OCI may have made the difference between life and death is unknown because multiple studies have shown that these injuries can be missed with current diagnostic methods. An improved understanding of the relative importance of OCI in blunt trauma mortality may help to refine protocols for the assessment and treatment of patients who arrive alive to the emergency room after severe blunt trauma. One way to improve our understanding is to document the relative frequency OCI relative to brain, liver, aorta, and spleen injuries in blunt trauma fatalities. PURPOSE In this study, we aimed to glean a more accurate estimate of the absolute and relative incidence of OCI after death from blunt trauma via a systematic review of data reported in the forensic literature. STUDY DESIGN Systematic literature review. METHODS A systematic literature search and review were undertaken. The search aimed to answer three primary questions: What is the true incidence of cervical spine injuries in blunt trauma fatalities? What is the incidence of dissociative OCIs specifically? and What is the incidence of these injuries relative to other common injuries associated with blunt trauma fatalities (central nervous system, spleen, liver, etc)? For that, two search protocols were used and included postmortem studies of blunt trauma mechanism in adult population. RESULTS The mean reported incidence of cervical spine injuries was 49.7% in blunt trauma fatalities. Dissociative OCIs were found to have a mean incidence of 18.1%. The relative frequencies of injuries were 49.7% for cervical spine, 41.8% for central nervous system, 20.8% for liver, 11.2% for spleen, and 10.8% for aorta. CONCLUSIONS In this systematic literature review, cervical spine injuries were found to be the most commonly reported finding associated with blunt trauma fatalities, occurring in nearly 50% of cases with occipitocervical dissociation accounting for nearly 20%. Older pathologic studies suggested a lesser overall and relative frequency and may have underestimated their incidence. Typically, these blunt cervical spine injuries were much more commonly found to disrupt the soft tissue stabilizing restraints (ligaments, facet capsules, etc) as opposed to causing bony fractures and, accordingly, were often not detected on plain radiographs. It is likely that the frequency of this injury is underestimated in patients surviving severe blunt trauma, placing them at risk for death from an occult source in the postinjury period. Additional research is needed to determine if improved methods to diagnose OCI and improved patient management protocols to protect against secondary injuries might reduce mortality in blunt trauma victims.
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Affiliation(s)
- Ran Lador
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, USA
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Horn EM, Feiz-Erfan I, Lekovic GP, Dickman CA, Sonntag VKH, Theodore N. Survivors of occipitoatlantal dislocation injuries: imaging and clinical correlates. J Neurosurg Spine 2007; 6:113-20. [PMID: 17330577 DOI: 10.3171/spi.2007.6.2.113] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECT Although rare, traumatic occipitoatlantal dislocation (OAD) injuries are associated with a high mortality rate. The authors evaluated the imaging and clinical factors that determined treatment and were predictive of outcomes, respectively, in survivors of this injury. METHODS The medical records and imaging studies obtained in 33 patients with OAD were reviewed retrospectively. Clinical factors that predicted outcomes, especially neurological injury at presentation and imaging findings, were evaluated. The most sensitive method for the diagnosis of OAD was the measurement of basion axial-basion dens interval on computed tomography (CT) scanning. Five patients with severe traumatic brain injuries (TBIs) were not treated and subsequently died. Of the 28 patients in whom treatment was performed, 23 underwent fusion and five were fitted with an external orthosis. Abnormal findings of the occipitoatlantal ligaments on magnetic resonance (MR) imaging, associated with no or questionable abnormalities on CT scanning, provided the rationale for nonoperative treatment. Of the 28 patients treated for their injuries, perioperative death occurred in five, three of whom had presented with severe neurological injuries. The mortality rate was highest in patients with a TBI at presentation. The mortality rate was lower in patients presenting with a spinal cord injury, but in this group there was a higher rate of persistent neurological deficits. CONCLUSIONS The spines in patients with CT-documented OAD are most likely unstable and need surgical fixation. In patients for whom CT findings are normal and MR imaging findings suggest marginal abnormalities, nonoperative treatment should be considered. The best predictors of outcome were severe brain or upper cervical injuries at initial presentation.
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Affiliation(s)
- Eric M Horn
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA
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Abstract
Atlanto-occipital dislocation, once considered rare and fatal, has become more common. Reasons for improved survival are training, efforts of prehospital care givers, improved diagnostics, and a collaborative healthcare approach to the patient. Advanced prehospital care strategies and diligence in educating prehospital providers are the core elements in preventing further injury and facilitating injury identification. Coupled with improved diagnostics, time to injury identification and treatment initiation is accelerated. This pediatric case study presents a coordinated plan of care demonstrating appropriate prehospital strategies and a team approach to care resulting in a positive patient outcome.
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Gautschi OP, Woodland PR, Zellweger R. Complete medulla/cervical spinal cord transection after atlanto-occipital dislocation: An extraordinary case. Spinal Cord 2006; 45:387-93. [PMID: 17003771 DOI: 10.1038/sj.sc.3101975] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Case report. SUMMARY OF BACKGROUND DATA Traumatic atlanto-occipital dislocation (AOD) with a complete medulla/spinal cord transection is rare and believed to be fatal owing to the high level of the spinal cord injury. Clinical outcome is poor. Consequently, relatively few case reports of adult patients surviving this injury appear in the literature. OBJECTIVES AND RESULT: We present the case of a 20-year-old male, who sustained an AOD with a complete medulla/spinal cord transection in a motorcycle accident to discuss the possibility of long-term survival with this condition. The patient underwent occipito-cervical stabilization. With an Injury Severity Score of 75, by definition unsurvivable, the patient is 16 months after the injury, ventilated and fully dependent for all care. CONCLUSION Long-term survival following AOD with a complete medulla/spinal cord transection is possible if immediate resuscitation at the scene is available. Nevertheless, it remains questionable whether or not a patient with such a devastating injury and without any prospect of functional recovery should be kept alive under all circumstances.
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Affiliation(s)
- O P Gautschi
- Department of Orthopaedic and Trauma Surgery, Royal Perth Hospital, Perth, Western Australia
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