Traumatic atlanto-occipital disruption in children

Ten cases of traumatic atlanto-occipital disruption in pediatric patients are reported. All injuries resulted from motor vehicle accidents, the majority of which were pedestrian/automobile. Three patients survived their injury for a period greater than one year. The importance of recognizing atlanto-occipital disruption is stressed because of its relative frequency in severely traumatized pediatric patients, particularly pedestrian/vehicle incidents, and because of the potential for survival. Diagnosis, in most instances, is based on the lateral cervical spine radiograph. The most applicable diagnostic features in children, as demonstrated on the lateral cervical spine radiograph, are reviewed.