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Traumatic atlanto-occipital dislocation in children.

Nelson Astur, Jeffrey R Sawyer, Paul Klimo

    The Journal of the American Academy of Orthopaedic Surgeons
    |May 3, 2014
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    Summary

    Atlanto-occipital dislocation (AOD) is now survivable due to improved diagnosis and management. Early surgical fusion is recommended for children, while halo immobilization is contraindicated.

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    Area of Science:

    • Pediatric Traumatology
    • Neurosurgery
    • Orthopedic Surgery

    Background:

    • Atlanto-occipital dislocation (AOD) was historically considered invariably fatal.
    • Advances in diagnostic and management strategies have improved survival rates for AOD.
    • AOD requires specialized pediatric care due to unique anatomical and physiological considerations.

    Purpose of the Study:

    • To review the current understanding and management of atlanto-occipital dislocation (AOD) in children.
    • To highlight the importance of early surgical intervention for pediatric AOD.
    • To discuss potential complications and long-term outcomes following AOD in pediatric patients.

    Main Methods:

    • Review of current literature on pediatric atlanto-occipital dislocation.
    • Discussion of diagnostic modalities, including MRI and fluoroscopy.
    • Analysis of surgical techniques for occipitocervical fusion and their outcomes.

    Main Results:

    • MRI is the preferred imaging modality for diagnosing AOD.
    • Early occipitocervical fusion using various techniques (screws, rods, plates, wires, autograft) offers immediate stabilization and high fusion rates.
    • Halo immobilization and traction are contraindicated in pediatric AOD due to displacement risks.

    Conclusions:

    • Atlanto-occipital dislocation (AOD) in children is a survivable injury with appropriate management.
    • Early surgical stabilization is crucial for achieving stability and fusion.
    • Potential complications include postoperative hydrocephalus, and residual neurologic deficits are common in survivors.