[Diagnosis and treatment of atlanto-occipital ruptures]

Atlantooccipital rupture is a rare ligamentous injury, which is usually accompanied by multiple trauma. Literature and personal communications report of 30 patients with such an injury. Long term survival is known in 18 cases, but there were severe neurological deficits in two cases. Reports of five of our own patients are presented. Death occurred after a few hours in three cases. One patient survived for four weeks, and one girl fully recovered after timely atlantooccipital fusion. In seven of 18 cases who have survived for a long time, the diagnosis was made only at a late stage. This underscores the necessity of including the occipitocervical transition in the diagnosis of the cervical spine. This applies in particular to unconscious accident casualties. Standard X-rays of the upper cervical spine (supplemented if necessary by cautious radiographic control under mild head extension) verify the diagnosis. In treatment, an early fusion of the cervicooccipital transition is to be given preference. Only in this way can stable healing and thus the most important precondition for neurological restitution be fulfilled.