Posterior atlanto-occipital dislocation and concomitant discoligamentous C3-C4 instability with survival

Study Design. A case report is presented. Objectives. To describe the diagnostic procedure, treatment, and outcome of a 56-year-old man with posterior atlanto-occipital dislocation and concomi tant discoligamentous C3-C4 instability. Case Report. A 56-year-old male seat-belted driver of a car was involved in an accident. After initial spontaneous breathing and weak movements of all his extremities, artificial respiration became necessary because of increa sing respiratory insufficiency. Radiologic diagnostics, including computed tomography scans, showed a posterior atlanto-occipital dislocation and a Gr ade 2 craniocerebral trauma with occipital subarachnoidal bleeding. Further examination showed a serial rib fracture with concomitant hemopneumothorax . After stabilization of the patient, magnetic resonance imaging of the cer vical spine showed a contusion of the upper cervical spinal cord. Additiona lly, rupture of the interspinal ligaments and the posterior longitudinal li gament could be seen, as well as a rupture of the intervertebral C3-C4 disc . Operative stabilization was performed by posterior fusion of C0-C4 using the CerviFix-System and autogenous bone grafts taken from the iliac crest. At 12 months after the operation, the patient had only slight weakness of t he left arm and a 70% limitation in the range of motion of the cervical spi ne. Conclusions. With improvements in advanced trauma life support, the number of patients with atlanto-occipital dislocation admitted to hospital alive i s increasing, so this particular lesion must be kept in mind. When the pati ent survives the accident, the long-term prognosis is quite good, with a hi gh rate of recovery after initial neurologic deficits.