Traumatic Atlanto-occipital Dislocation (AOD)

Area of Science:

• Traumatology
• Neurosurgery
• Radiology

Background:

• Traumatic atlanto-occipital dislocation (AOD) is a rare but often fatal high-energy injury affecting the cervicomedullary junction.
• Recent advancements in prehospital care, diagnostics, and treatment have led to increased survival rates.
• This study focuses on initial imaging modalities for AOD to identify clinical features and aid rapid diagnosis.

Purpose of the Study:

• To recognize the clinical features of traumatic atlanto-occipital dislocation (AOD).
• To evaluate diagnostic considerations for quick diagnosis of AOD.
• To analyze initial imaging findings in patients with traumatic AOD.

Main Methods:

• Retrospective review of five adult patients who survived traumatic atlanto-occipital dislocation (AOD).
• Diagnosis confirmed using lateral cervical spine X-ray, CT, or MRI.
• Treatment involved early immobilization, respiratory support, and occipitocervical fusion.

Main Results:

• Four male and one female patient were included; diagnoses were early in three and delayed in two.
• Four patients had Type II AOD, and one had Type I AOD.
• All patients underwent occipitocervical fusion; two showed neurological decline, and three had no change. Prevertebral soft tissue swelling at C2 was noted in all, with an average thickness of 17.88 mm. Abnormalities in the dens-basion index and Power's ratio were observed in some patients.

Conclusions:

• Severe prevertebral soft tissue swelling at C2 in trauma patients warrants careful evaluation for atlanto-occipital dislocation (AOD).
• 3D CT or MRI may be considered to confirm AOD in suspected cases.
• Prompt diagnosis and management are crucial for improving outcomes in traumatic AOD.