Incidence and outcome of atlanto-occipital dissociation at a level 1 trauma centre: a prospective study of five cases within 5 years.
BACKGROUND
Prospective evaluation of atlanto-occipital dissociations (AODs) at a level 1 trauma centre within 5 years.


METHODS
Over a period of 5 years (2005-2009), all CT scans of the skull base and the upper cervical spine due to traumatic injuries were prospectively entered into a database. Furthermore, in cases of confirmed AOD all empirical data were prospectively collected. A more detailed data analysis of all AOD patients was conducted 2 years post-trauma. If required, another prospective follow-up was performed.


RESULTS
2,616 CT scans were performed in total. Out of these, there were five male patients with confirmed AOD. Thus, the total incidence was 0.2 %. AOD was associated with occipital condyle fractures in three out of the five cases. Three out of five patients (60 %) died due to the severity of the injury. It was possible to stabilise two patients surgically with a clinical/radiological follow-up 2 years post-surgery. At that time, one patient had an incomplete tetraplegia and was wheelchair ridden without needing ventilation, while the other patient suffered from post-traumatic stress disorder, but was able to walk and live alone.


CONCLUSIONS
AOD is a rarely seen injury, even in a level 1 trauma centre, and is associated with high morbidity and mortality. However, it is possible for adults to survive this severe occipito-cervical injury after surgical repair while maintaining the ability to walk. All the results and recommendations are still based on a low level of evidence, due to the low incidence of this injury.
Department of Trauma Surgery, University Hospital Regensburg, 93042 Regensburg, Germany. muellerfj5@aol.com
Franz Josef
FJ
Mueller
Bernd
B
Kinner
Michael
M
Rosskopf
Carsten
C
Neumann
Michael
M
Nerlich
Bernd
B
Fuechtmeier
D000293:Adolescent; D000328:Adult; D001174:Arthrodesis; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D006801:Humans; D015994:Incidence; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D055815:Young Adult