Anji Tang1, Daniel Tobert2, Sujay Kakarmath3, Mitchel Harris2, Bharti Khurana4,5. 1. Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA. 2. Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA. 3. Center for Clinical Data Science, Mass General Brigham, 100 Cambridge St., Boston, MA, 02115, USA. 4. Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA, 02115, USA. bkhurana@bwh.harvard.edu. 5. Trauma Imaging Research and Innovation Center, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA. bkhurana@bwh.harvard.edu.
Abstract
PURPOSE: We aimed to describe the findings of traumatic atlanto-occipital dislocation (AOD) on cervical spine CTs and differences leading to varying treatment of these patients. METHODS: We retrospectively identified 20 adult patients with AOD from cervical spine CTs demonstrating fracture or fracture dislocations over 19 years at 2 major trauma centers. Medical records were reviewed and craniovertebral junction (CVJ) metrics measured on CT. Intubation, Glasgow Coma Scale (GCS), additional injuries, occiput/atlas/axis fracture, concurrent atlantoaxial subluxation, vascular injury on CT angiography, and ligamentous injury on MRI were noted. RESULTS: Using the Traynelis Classification, eight patients had type 2 and eight patients type 3 AOD. Four of 5 patients who died within 14 days of CT had type 2 AOD. Three patients had medial/lateral AOD. Of the patients who survived initial injuries, a greater percentage who underwent surgical or halo fixation versus non-operatively treated patients had abnormal CVJ measurements including BDI (62.5% vs 0%), atlantoaxial subluxation (75% vs 14.3%), ligamentous injury (80% vs 66.7%), intubation (62.5% vs 28.6%), GCS<8 (62.5% vs 14.3%), and additional injuries (75% vs 71.4%) on presentation. MRI helped identify 2 cases of type 2 AOD and surgical decision making in 8 cases. CONCLUSIONS: Types 2 and 3 were the most common, and type 2 is the deadliest type of AOD. A greater proportion of patients who undergo surgical or halo fixation have abnormal CT/MR findings with neurologic impairment at presentation. MRI aided detection of potentially missed type 2 AOD and was critical for surgical decision making.
PURPOSE: We aimed to describe the findings of traumatic atlanto-occipital dislocation (AOD) on cervical spine CTs and differences leading to varying treatment of these patients. METHODS: We retrospectively identified 20 adult patients with AOD from cervical spine CTs demonstrating fracture or fracture dislocations over 19 years at 2 major trauma centers. Medical records were reviewed and craniovertebral junction (CVJ) metrics measured on CT. Intubation, Glasgow Coma Scale (GCS), additional injuries, occiput/atlas/axis fracture, concurrent atlantoaxial subluxation, vascular injury on CT angiography, and ligamentous injury on MRI were noted. RESULTS: Using the Traynelis Classification, eight patients had type 2 and eight patients type 3 AOD. Four of 5 patients who died within 14 days of CT had type 2 AOD. Three patients had medial/lateral AOD. Of the patients who survived initial injuries, a greater percentage who underwent surgical or halo fixation versus non-operatively treated patients had abnormal CVJ measurements including BDI (62.5% vs 0%), atlantoaxial subluxation (75% vs 14.3%), ligamentous injury (80% vs 66.7%), intubation (62.5% vs 28.6%), GCS<8 (62.5% vs 14.3%), and additional injuries (75% vs 71.4%) on presentation. MRI helped identify 2 cases of type 2 AOD and surgical decision making in 8 cases. CONCLUSIONS: Types 2 and 3 were the most common, and type 2 is the deadliest type of AOD. A greater proportion of patients who undergo surgical or halo fixation have abnormal CT/MR findings with neurologic impairment at presentation. MRI aided detection of potentially missed type 2 AOD and was critical for surgical decision making.
Authors: Shekhar D Khanpara; Jennifer L McCarty; Karl M Schmitt; Jessica R Stark; O Clark West; Xu Zhang; Roy F Riascos Journal: Emerg Radiol Date: 2020-07-30