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Updated: Aug 14, 2025
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Atlanto-occipital dislocation with concomitant severe traumatic brain injury: A retrospective study at a level 1
Daniel García-Pérez1, Irene Panero1, Alfonso Lagares1
1Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain.
Insights
Traumatic atlanto-occipital dislocation (AOD) with severe traumatic brain injury (TBI) is often fatal, but some patients can be salvaged. Early surgical intervention in survivors with neurological improvement can lead to significant recovery.
Area of Science:
- Neurosurgery
- Traumatology
- Radiology
Background:
- Traumatic atlanto-occipital dislocation (AOD) is a critical injury.
- Severe traumatic brain injury (TBI) increases mortality in AOD patients.
- Limited individual analysis exists for AOD patients with TBI.
Purpose of the Study:
- To analyze the epidemiology, injury mechanisms, associated injuries, and outcomes of AOD patients with severe TBI.
- To identify predictors of mortality and factors influencing neurological recovery in this patient cohort.
Main Methods:
- Retrospective study of patients aged ≥16 diagnosed with AOD and severe TBI (2010-2020).
- Examination of epidemiological data, injury mechanisms, associated injuries, and patient outcomes.
- Analysis of diagnostic imaging including CT and MRI, focusing on AOD diagnostic criteria like Basion Dens Interval (BDI) and Condyle-C1 interval (CCI).
Main Results:
- Eight patients were included; six died before intervention.
- Two patients underwent occipito-cervical fixation and showed neurological improvement.
- Cardiorespiratory arrest (CRA) predicted death; diffuse axonal injury (DAI) was common.
- BDI and CCI sum were reliable AOD diagnostic criteria; condylar avulsion fractures indicated AOD suspicion.
Conclusions:
- Patients with AOD and severe TBI may be salvageable.
- Prompt surgical treatment in survivors with neurological improvement can result in significant recovery.
- Early recognition of AOD signs on CT is crucial for timely management.
Background:
Traumatic atlanto-occipital dislocation (AOD) is a life-threatening injury. Although traumatic brain injury (TBI) is associated with increased mortality in AOD patients, a detailed individual analysis of these patients is lacking in the literature.
Methods:
Patients ≥16 years old who were diagnosed of AOD with concomitant severe TBI from 2010 to 2020 were included in this retrospective study. We examined the epidemiology, injury mechanisms, associated injuries, and outcomes of these patients.
Results:
Eight patients were included. Six patients died before any intervention could be performed, and two patients underwent an occipito-cervical fixation, showing a notorious neurologic improvement on follow-up. Cardiorespiratory arrest (CRA) was a strong predictor of subsequent death. CT signs of diffuse axonal injury (DAI) were present in most patients and were confirmed by magnetic resonance imaging (MRI) in survivors. Although TBI was not the main cause of death, it was responsible for the delayed neurological improvement and deferred stabilization. The average sensitivity of the different used methodologies for AOD diagnosis ranged from 0.50 to 1.00, being the Basion Dens Interval (BDI) and the Condyle-C1 interval (CCI) sum the most reliable criteria. Non-survivors tended to show greater distraction measurements. The high incidence of condylar avulsion fractures suggests that their visualization on the initial CT study should heighten the suspicion for AOD.
Conclusions:
Our data suggest that patients with AOD and concomitant severe TBI might be salvageable patients. In those who survive beyond the first hospital days and show neurological improvement, surgical treatment should be performed as they can achieve an important neurologic recovery.
