CHILDHOOD SURVIVAL OF ATLANTOOCCIPITAL DISLOCATION - UNDERDIAGNOSIS, RECOGNITION, TREATMENT, AND REVIEW OF THE LITERATURE

Traumatic childhood atlantooccipital dislocation (AOD) may be overlook ed, especially in patients with concomitant closed head injury and mul tiple trauma. We diagnosed and treated 4 children with traumatic AOD s een in less than a 2-year period. We found published descriptions of o nly 15 other survivors of childhood traumatic AOD in the literature. C linical histories, radiographic findings, treatment, outcome, and comp lications in these 15 children as well as our 4 patients were reviewed . The age distribution of childhood AOD survivors (average age 6.8 yea rs) closely resembles that of pediatric multiple trauma patients. Earl y diagnosis of traumatic AOD hinges on precise interpretation of the l ateral cervical radiograph. Longitudinal AOD was seen most often. Usua lly these children presented with cranial nerve palsies, major motor d eficits, and depressed level of consciousness. Most underwent posterio r atlantooccipital fusion. Outcome varied from normal neurological fun ction to prolonged ventilator dependency and delayed demise. AOD must be diagnosed early to avoid attributing potentially reversible neurolo gic changes to irreversible injuries since closed head injury and high spinal cord dysfunction may be confused clinically and the outcome of a patient with AOD is unpredictable.