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Traumatic atlanto-occipital dislocation in children
P Houle1, D E McDonnell, J Vender
1Section of Neurosurgery, Medical College of Georgia, Augusta, Ga. 30912, USA. phoule@mail.mcg.edu
Insights
Traumatic atlanto-occipital dislocation, a severe pediatric injury, is increasingly survivable due to improved field resuscitation. A novel internal fixation technique achieved solid fusion without external bracing in two cases.
Area of Science:
- Orthopedics
- Trauma Surgery
- Pediatric Neurosurgery
Background:
- Traumatic atlanto-occipital dislocation is a severe injury in pediatric trauma.
- Improved field resuscitation has increased patient survival, necessitating effective treatment strategies.
Purpose of the Study:
- To evaluate the efficacy of Locksley intersegmental tie bar occipital cervical fusion for traumatic atlanto-occipital dislocation.
- To determine if this internal fixation method can obviate the need for external orthosis.
Main Methods:
- Two pediatric cases of traumatic atlanto-occipital dislocation were treated.
- The treatment involved Locksley intersegmental tie bar occipital cervical fusion.
Main Results:
- Both patients achieved solid bony fusion.
- Neither patient required supplemental halo bracing.
- Both patients experienced complete neurologic recovery.
Conclusions:
- Locksley intersegmental tie bar occipital cervical fusion is a viable and effective treatment for traumatic atlanto-occipital dislocation.
- This technique provides rigid internal fixation, eliminating the need for external immobilization.
- Early surgical stabilization is crucial for potentially survivable atlanto-occipital injuries.
Abstract:
Traumatic atlanto-occipital dislocation is seen in approximately 25% of fatal pediatric trauma. This was previously considered to be a rare and fatal entity, however with improvements in resuscitation in the field, many patients who previously might have died are now evaluated in the hospital. Treatment of atlanto-occipital instability is internal fixation. Many authors have advocated supplemental external immobilization with a halo vest. However, there are several circumstances where the application of a halo vest is undesirable. Thus a method of internal fixation and fusion that is rigid enough not to require supplemental external orthosis is necessary. We present 2 cases of atlanto-occipital dislocation which were treated with Locksley intersegmental tie bar occipital cervical fusion. Both patients achieved solid fusion without supplemental halo bracing, and made complete neurologic recoveries. Traumatic atlanto-occipital dislocation is a potentially survivable injury that requires aggressive resuscitation in the field, a high index of suspicion and early definitive surgical stabilization.
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