TRAUMATIC OCCIPITOATLANTAL DISLOCATIONS

Fourteen occipitoatlantal dislocations were treated during an 11-year period. All patients presented with neurological deficits and definite evidence of spinal instability. Plain radiographs provided the diagno sis conclusively in 11 patients. Three patients required computed tomo graphy (CT) or magnetic resonance (MR) imaging for diagnosis. Rotation al subluxations were radiographically occult and associated with less severe neurological injuries compared to distracted or translated subl uxations. Ten patients died acutely. One patient, who had complete C1 level quadriplegia, died after 3 months. Three patients with incomplet e spinal cord syndromes had long-term survival and functional neurolog ical recoveries. Extensive ligamentous injury predisposed patients to recurrent subluxations. In several patients, traction or a cervical co llar caused distraction and neurological injury. Halo immobilization a nd urgent fusion are necessary for patients with salvageable neurologi cal function. Nonoperative measures are inadequate for immediate or lo ng-term spinal stability.