Gertz K, Cornett C, Gannon E. Successful non-operative treatment of traumatic atlanto-occipital dislocation: a case report.
JOURNAL OF SPINE SURGERY (HONG KONG) 2023;
9:472-478. [PMID:
38196734 PMCID:
PMC10772660 DOI:
10.21037/jss-23-60]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/29/2023] [Indexed: 01/11/2024]
Abstract
Background
Traumatic atlanto-occipital dislocation (AOD) is most commonly treated with cranio-cervical fusion. We present a unique case in which a partial neurological recovery was made after non-operative treatment was done for AOD. Reports of non-operative treatment of this condition are rare in the literature.
Case Description
An 18-year-old male sustained a traumatic AOD and atlanto-axial dislocation. His injury was characterized by bony avulsion fractures of the occipital condyles bilaterally as well as atlanto-axial dissociation. Non-operative treatment was done because of his comorbidities, primarily his morbid obesity. He was treated in a hard cervical collar for 6 months. He showed radiographic evidence of healing after being treated non-operatively in a rigid cervical collar for 6 months. Follow up at 17 months showed a partial neurological recovery with ability to ambulate assisted with a walker.
Conclusions
Successful outcomes are possible with non-operative treatment of AOD. A predominant factor contributing to this patient's successful outcome with non-operative management was likely related to the bony avulsion fractures he had which allowed bone to bone healing and settling of the fracture with gravity assisted reduction in a collar. Non-operative treatment may be considered in patients who are too unhealthy or unstable to undergo surgical intervention, although the standard of care remains surgical cranio-cervical fusion.
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