Traumatic occipitoatlantal dislocation.
BACKGROUND
Traumatic occipitoatlantal dislocation (OAD) is a severe ligamentous injury resulting in instantaneous death or severe neurological deficit. However, survivors of OAD, both short and long term, have been increasingly reported; this may be because of improved prehospital care, more rapid transportation, a high index of suspicion, and new radiological techniques.


METHODS
The medical records and film of three patients who had traumatic OAD were retrospectively reviewed. Diagnosis was made by lateral cervical spine radiography, computed tomography (CT), or magnetic resonance imaging (MRI). Treatment consisted of early respiratory support and subsequent posterior surgical fusion.


RESULTS
The three survivors of traumatic OAD represent 3.1% of all cervical spine injuries in our service. Two were children and the other was a 64-year-old man, all of whom suffered from severe neurological deficits. Lateral cervical spine radiographs led to the diagnosis of OAD. Two were longitudinal, and one was anterior. Two patients died within 2 weeks after injury. The remaining patient, who had anterior OAD, survived longer, which allowed posterior fusion with a U-shape Steinman pin and wiring to be performed. However, she died 5 months after injury because of septicemia.


CONCLUSIONS
Early recognition and treatment may improve the outcome of this injury. Treatment consists of early respiratory support and subsequent surgical fusion.
Saeheng
S
S
Division of Neurological Surgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand 90112.
Phuenpathom
N
N
D001269:Atlanto-Occipital Joint / Q000293:injuries* / Q000601:surgery; D002675:Child, Preschool; D017809:Fatal Outcome; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013123:Spinal Fusion; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome