Complete medulla/cervical spinal cord transection after atlanto-occipital dislocation: an extraordinary case.
METHODS
Case report.


BACKGROUND
Traumatic atlanto-occipital dislocation (AOD) with a complete medulla/spinal cord transection is rare and believed to be fatal owing to the high level of the spinal cord injury. Clinical outcome is poor. Consequently, relatively few case reports of adult patients surviving this injury appear in the literature. OBJECTIVES AND RESULT: We present the case of a 20-year-old male, who sustained an AOD with a complete medulla/spinal cord transection in a motorcycle accident to discuss the possibility of long-term survival with this condition. The patient underwent occipito-cervical stabilization. With an Injury Severity Score of 75, by definition unsurvivable, the patient is 16 months after the injury, ventilated and fully dependent for all care.


CONCLUSIONS
Long-term survival following AOD with a complete medulla/spinal cord transection is possible if immediate resuscitation at the scene is available. Nevertheless, it remains questionable whether or not a patient with such a devastating injury and without any prospect of functional recovery should be kept alive under all circumstances.
Gautschi
O P
OP
Department of Orthopaedic and Trauma Surgery, Royal Perth Hospital, Perth, Western Australia.
Woodland
P R
PR
Zellweger
R
R
D000063:Accidents, Traffic; D000328:Adult; D001269:Atlanto-Occipital Joint / Q000293:injuries*; D001794:Blood Pressure / Q000502:physiology; D005593:Fracture Fixation, Internal; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D004204:Joint Dislocations / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000293:injuries*; D009049:Motorcycles; D009460:Neurologic Examination; D013116:Spinal Cord / Q000000981:diagnostic imaging; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed