title: Atlantooccipital dislocation in children: presentation, diagnosis, and management.
abstract: Atlantooccipital dislocation (AOD) injuries are highly unstable, and usually result in significant neurological injury and death. Recently the postinjury survival period has increased. In a review of the literature the authors found 41 cases in which survival was greater than 48 hours. This is likely due to improved on-scene resuscitation, spinal immobilization, transportation, new diagnostic techniques, and a higher index of suspicion. Diagnosis is usually made with plain cervical radiographs, but there are shortcomings associated with this modality in the pediatric population. Diagnosis is aided by high-resolution computerized tomography and magnetic resonance imaging. Infants and toddlers may undergo orthotic immobilization alone, whereas older children usually undergo early occipital cervical fusion. Those with incomplete AOD may be managed successfully with orthotic immobilization.
authors.affiliation: Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. steinmm@ccf.org
authors.forename: Michael P
authors.initials: MP
authors.lastname: Steinmetz
authors.forename: Roseanna M
authors.initials: RM
authors.lastname: Lechner
authors.forename: James S
authors.initials: JS
authors.lastname: Anderson
mesh_terms: D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016025:Bone Transplantation; D019090:Case Management; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D020209:Cranial Nerve Injuries / Q000150:complications; D006259:Craniocerebral Trauma / Q000150:complications; D006801:Humans; D007103:Immobilization; D007223:Infant; D007231:Infant, Newborn; D004204:Joint Dislocations / Q000145:classification / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy; D008279:Magnetic Resonance Imaging; D009989:Orthotic Devices; D019736:Prostheses and Implants; D012121:Respiration, Artificial; D013123:Spinal Fusion; D014057:Tomography, X-Ray Computed