title: Combined traumatic occiput-C1 and C1-C2 dissociation: 2 case reports.
abstract: Occiput-C1 and C1-C2 dissociations and dislocations have been well documented in the literature. However, after thorough review of the literature, we found very little in the literature regarding combined occiput-C1 and C1-C2 dissociations in adults who survived. We present 2 case reports describing the clinical presentation, initial management, operative treatment, and postoperative course of 2 patients who sustained traumatic combined occiput-C1 and C1-C2 dissociations. After initial stabilization, both patients underwent open reduction and posterior occipital-cervical fusion with segmental fixation. At recent follow-up, both patients maintain good sagittal alignment without loss of reduction, and they have radiographic progression to fusion, minimal pain, and improved neurologic function. Combined occiput-C1 and C1-C2 dissociations are rare but serious injuries. Incomplete dissociations may not be evident on initial radiographs. Computed tomography or magnetic resonance imaging is recommended for formal diagnosis. A traumatic dural tear may be present. We recommend open reduction and posterior occipital-cervical fusion with segmental fixation for these patients.
authors.affiliation: Department of Orthopaedics, Stony Brook University Medical Center, NY 11794, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Gould
authors.forename: Shuriz
authors.initials: S
authors.lastname: Hishmeh
authors.forename: Bart
authors.initials: B
authors.lastname: McKinney
authors.forename: Mark
authors.initials: M
authors.lastname: Stephen
mesh_terms: D000063:Accidents, Traffic; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005260:Female; D005592:Fracture Fixation / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D009777:Occipital Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D011859:Radiography; D013123:Spinal Fusion / Q000379:methods; D013124:Spinal Injuries; D016896:Treatment Outcome; D055815:Young Adult