Treatment of traumatic atlanto-occipital dislocation in chronic phase.
We report the case of 27-year-old woman who presented with mild neurological deficits with significant anterior dislocation of the atlanto-occipital junction in a chronic phase after initial conservative treatment in another hospital. The importance of early diagnosis and treatment for atlanto-occipital dislocation is emphasized. The dislocation could not be reduced sufficiently either by halo ring cervical traction or surgical procedure 5 months after the accident. Therefore, transoral odontoidectomy for decompression of the medulla, together with the posterior occipitocervical fusion with a titanium loop brace was performed. The patient's symptoms disappeared completely within a few months after the operation. Magnetic resonance imaging findings suggesting soft tissue damage is the key to an early diagnosis and subsequent stabilization of traumatic atlanto-occipital dislocation in the early phase. Transoral decompressive odontoidectomy combined with posterior fusion may be considered for the treatment of irreducible atlanto-occipital dislocation in a chronic phase.
Takayasu
M
M
Department of Neurosurgery, Nagoya University School of Medicine, Japan. mtakayas@med.nagoya-u.ac.jp
Hara
M
M
Suzuki
Y
Y
Yoshida
J
J
D000328:Adult; D001269:Atlanto-Occipital Joint / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D004204:Joint Dislocations / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D009809:Odontoid Process / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis; D013123:Spinal Fusion; D014057:Tomography, X-Ray Computed; D014911:Whiplash Injuries / Q000175:diagnosis / Q000601:surgery*