Traumatic atlanto-occipital dislocation with survival: case report and review

Traumatic atlanto-occipital (A-O) dislocation is a rare injury that is associated with a high mortality rate. We are presenting the case of a 5-year-old child with this entity to illustrate the mechanism of injury, the often-confusing clinical picture, and the use of diaphragmatic fluoroscopy to localize the neurological lesion. We suggest using plain lateral roentgenograms, anteroposterior tomograms, and a cervical computed tomographic scan to confirm the diagnosis of A-O dislocation. We strongly favor using the halo apparatus for immediate immobilization and posterior occipitoatlantoaxial fusion for long term stability. The various diagnostic radiographic criteria for A-O dislocation are compared and discussed.