Timely recognition of traumatic atlanto-occipital dislocation in a child based on occipital condyle–C1 interval analysis: excellent neurological recovery

Case report

Vicko Gluncic M.D., Ph.D., Michael Turner M.D., Ph.D., Leonard Kranzler M.D., and David Frim M.D., Ph.D.
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  • Section of Neurosurgery, The University of Chicago Medical Center, Chicago, Ilinois
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A case of atlanto-occipital dislocation (AOD) is presented to illustrate the importance of subtle imaging findings and the occipital condyle–C1 interval (CCI) measurement in the evaluation of high cervical spine injury. Although AOD is commonly considered to be fatal, recently there have been an increasing number of reports of children surviving this injury. Prompt recognition and treatment of AOD are crucial for survival.

The authors present a case of an 8-year-old boy who sustained a destabilizing injury without bone disruption but with ligamentous tears that rendered his cervical spine unstable from the occiput to the C-1 level. On admission, imaging findings were consistent with tectorial membrane damage, perimedullary subarachnoid hemorrhage, and extraaxial blood from the clivus to the C-2 level. Most standard cervical spine radiological indices were within normal limits except the CCI. After initial management in a cervical collar, the patient was placed in halo vest, and subsequently underwent occiput to C-3 fusion. Timely recognition of the injury and subsequent craniocervical stabilization with internal fixation resulted in full neurological recovery. This report supports CCI as a valuable index for the prompt recognition of AOD. It also supports recent literature suggesting that AOD is a survivable injury with the possibility for an excellent neurological recovery.

Abbreviations used in this paper:

AOD = atlanto-occipital dislocation; CCI = condyle–C1 interval; GCS = Glasgow Coma Scale; SAH = subarachnoid hemorrhage.

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  • 1

    Belzberg AJ, & Tranmer BI: Stabilization of traumatic atlantooccipital dislocation. Case report. J Neurosurg 75:478482, 1991

  • 2

    Bucholz RW, & Burkhead WZ: The pathological anatomy of fatal atlanto-occipital dislocations. J Bone Joint Surg Am 61:248250, 1979

  • 3

    Bulas DI, , Fitz CR, & Johnson DL: Traumatic atlanto-occipital dislocation in children. Radiology 188:155158, 1993

  • 4

    Cohen A, , Hirsch M, , Katz M, & Sofer S: Traumatic atlanto-occipital dislocation in children: review and report of five cases. Pediatr Emerg Care 7:2427, 1991

    • Search Google Scholar
    • Export Citation
  • 5

    Dickman CA, , Papadopoulos SM, , Sonntag VK, , Spetzler RF, , Rekate HL, & Drabier J: Traumatic occipitoatlantal dislocations. J Spinal Disord 6:300313, 1993

    • Search Google Scholar
    • Export Citation
  • 6

    Donahue DJ, , Muhlbauer MS, , Kaufman RA, , Warner WC, & Sanford RA: Childhood survival of atlantooccipital dislocation: underdiagnosis, recognition, treatment, and review of the literature. Pediatr Neurosurg 21:105111, 1994

    • Search Google Scholar
    • Export Citation
  • 7

    Dublin AB, , Marks WM, , Weinstock D, & Newton TH: Traumatic dislocation of the atlanto-occipital articulation (AOA) with short-term survival. With a radiographic method of measuring the AOA. J Neurosurg 52:541546, 1980

    • Search Google Scholar
    • Export Citation
  • 8

    Eismont FJ, & Bohlman HH: Posterior atlanto-occipital dislocation with fractures of the atlas and odontoid process. J Bone Joint Surg Am 60:397399, 1978

    • Search Google Scholar
    • Export Citation
  • 9

    Eleraky MA, , Theodore N, , Adams M, , Rekate HL, & Sonntag VKH: Pediatric cervical spine injuries: report of 102 cases and review of the literature. J Neurosurg 92:1 Suppl 1217, 2000

    • Search Google Scholar
    • Export Citation
  • 10

    Ferrera PC, & Bartfield JM: Traumatic atlanto-occipital dislocation: a potentially survivable injury. Am J Emerg Med 14:291296, 1996

  • 11

    Garfin SR, , Botte MJ, , Waters RL, & Nickel VL: Complications in the use of the halo fixation device. J Bone Joint Surg Am 68:320325, 1986

    • Search Google Scholar
    • Export Citation
  • 12

    Gerlock AJ Jr, , Mirfakhraee M, & Benzel EC: Computed tomography of traumatic atlantooccipital dislocation. Neurosurgery 13:316319, 1983

  • 13

    Gore PA, , Chang S, & Theodore N: Cervical spine injuries in children: attention to radiographic differences and stability compared to those in the adult patient. Semin Pediatr Neurol 16:4258, 2009

    • Search Google Scholar
    • Export Citation
  • 14

    Harris JH Jr, , Carson GC, & Wagner LK: Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 162:881886, 1994

    • Search Google Scholar
    • Export Citation
  • 15

    Kaufman RA, , Carroll CD, & Buncher CR: Atlantooccipital junction: standards for measurement in normal children. AJNR Am J Neuroradiol 8:995999, 1987

    • Search Google Scholar
    • Export Citation
  • 16

    Matava MJ, , Whitesides TE Jr, & Davis PC: Traumatic atlantooccipital dislocation with survival. Serial computerized tomography as an aid to diagnosis and reduction: a report of three cases. Spine 18:18971903, 1993

    • Search Google Scholar
    • Export Citation
  • 17

    Pang D, , Nemzek WR, & Zovickian J: Atlanto-occipital dislocation—part 2: The clinical use of (occipital) condyle-C1 interval, comparison with other diagnostic methods, and the manifestation, management, and outcome of atlanto-occipital dislocation in children. Neurosurgery 61:9951015, 2007

    • Search Google Scholar
    • Export Citation
  • 18

    Pang D, , Nemzek WR, & Zovickian J: Atlanto-occipital dislocation: part 1—normal occipital condyle-C1 interval in 89 children. Neurosurgery 61:514521, 2007

    • Search Google Scholar
    • Export Citation
  • 19

    Pang D, & Wilberger JE Jr: Traumatic atlanto-occipital dislocation with survival: case report and review. Neurosurgery 7:503508, 1980

  • 20

    Shamoun JM, , Riddick L, & Powell RW: Atlanto-occipital subluxation/dislocation: a “survivable” injury in children. Am Surg 65:317320, 1999

    • Search Google Scholar
    • Export Citation
  • 21

    Traynelis VC, , Marano GD, , Dunker RO, & Kaufman HH: Traumatic atlanto-occipital dislocation. Case report. J Neurosurg 65:863870, 1986

  • 22

    Urdaneta F, & Layon AJ: Respiratory complications in patients with traumatic cervical spine injuries: case report and review of the literature. J Clin Anesth 15:398405, 2003

    • Search Google Scholar
    • Export Citation

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