Recognition and management of atlantooccipital dislocation: improving survival from an often fatal condition

Objective: To provide an overwiew of antlanto-occipital dislocation and ass ociated occipital condyle fractures so as to alert physicians to this rare injury and potentially improve patient outcome. The pertinent anatomy, mech anism of injury, clinical and radiologic evaluation and the management of t hese rare injuries are discussed in an attempt to alert physicians to this type of, injury and to improve outcome. Data sources: The data were obtaine d from a MEDLINE search of the English literature from 1966 to 1999 and the experience of 4 spine surgeons at a quaternary care acute spinal cord inju ry unit. Study selection: Detailed anatomic and epidemiologically sound rad iology Studies were identified and analyzed. Only small retrospective studi es or case series were available in the literature, Data extraction: Valid anatomic, biomechanical and radiologic evaluation was extracted from studie s. Clinical data came from limited studies and expert opinion. Data synthes is: Early diagnosis is essential and is facilitated by a detailed clinical examination and strict adherence to an imaging algorithm that includes CT a nd MRI scanning. When the dislocation is identified, timely gentle reductio n and prompt stabilization through nonoperative or operative means is found to optimize patient Outcome. Conclusions: Atlanto-occipital dislocation sh ould be suspected in any patient involved in a high speed motor vehicle or pedestrian collision. Once suspected, proper imaging and appropriate manage ment of these once fatal injuries can improve survival and neurologic outco me.