Traumatic atlanto-occipital dislocation with survival in children

Traumatic atlanto-occipital dislocation is a rarely seen clinical entity, because it is too often fatal. The case of an 8-year-old boy is presented with an anterior atlanto-occipital dislocation. He suffered from multiple injuries: severe head injury and coma, fractures of both femurs and one tibia. He was considered an incomplete spinal cord injury on admission. The diagnosis was suspected 4 days after admission, and a minimal cervical traction was applied for 4 weeks. At 5 years follow-up, clinical and radiologic status was normal. This case is compared with the 28 survivor children reported in the literature: 79% had incomplete neurologic lesions, and only 12 were normal at follow-up. Every report pointed out difficulties of initial clinical and radiologic diagnosis. Treatment is varied and controversial but, in children's cases, mild traction may be indicated in anterior and posterior displacement as initial management, and surgical stabilization performed early in longitudinal dislocation and deferred in displacement that remains unstable.