Context: Atlanto-occipital dissociation is a highly lethal ligamentous injury at the craniocervical junction (CCJ). Previous studies have described rare cases of milder forms of atlanto-occipital injury (AOI) which might be managed nonoperatively, but there is a paucity of literature on this subject. Aims: We retrospectively reviewed our institutional experience to characterize the injury patterns, treatments, and clinical courses of patients with unilateral AOI. Methods: We included patients with radiographic evidence of unilateral occipitocervical joint capsular disruption, distraction, or edema ± injury of the apical ligament, tectorial membrane, anterior atlanto-occipital membrane, posterior atlanto-occipital membrane, alar ligaments, or cruciate ligament. The long-term outcomes were gathered from medical records, and six patients were available for Neck Disability Index via phone call at the time of the study. Results: Eight patients were included in the study. The mean age was 45.1 years ± 26.5. Causes of trauma included motor vehicle collision for five patients (5/8, 62.5%), falls for two (2/8, 25), and assault for one (1/8, 12.5%). All patients had a widened condyle-C1 interval >2 mm. Three patients underwent occipitocervical fusion, one patient underwent atlantoaxial fusion, and another received subaxial fusions for other injuries. Three patients underwent no surgical intervention. All patients were seen at least once as an outpatient following hospital discharge. There were no delayed neurologic injuries or deaths. Conclusions: We propose that ligamentous injury at the CCJ functions more as a spectrum rather than dichotomous diagnosis, of which a subset can likely be safely managed nonoperatively. Copyright:
Context: Atlanto-occipital dissociation is a highly lethal ligamentous injury at the craniocervical junction (CCJ). Previous studies have described rare cases of milder forms of atlanto-occipital injury (AOI) which might be managed nonoperatively, but there is a paucity of literature on this subject. Aims: We retrospectively reviewed our institutional experience to characterize the injury patterns, treatments, and clinical courses of patients with unilateral AOI. Methods: We included patients with radiographic evidence of unilateral occipitocervical joint capsular disruption, distraction, or edema ± injury of the apical ligament, tectorial membrane, anterior atlanto-occipital membrane, posterior atlanto-occipital membrane, alar ligaments, or cruciate ligament. The long-term outcomes were gathered from medical records, and six patients were available for Neck Disability Index via phone call at the time of the study. Results: Eight patients were included in the study. The mean age was 45.1 years ± 26.5. Causes of trauma included motor vehicle collision for five patients (5/8, 62.5%), falls for two (2/8, 25), and assault for one (1/8, 12.5%). All patients had a widened condyle-C1 interval >2 mm. Three patients underwent occipitocervical fusion, one patient underwent atlantoaxial fusion, and another received subaxial fusions for other injuries. Three patients underwent no surgical intervention. All patients were seen at least once as an outpatient following hospital discharge. There were no delayed neurologic injuries or deaths. Conclusions: We propose that ligamentous injury at the CCJ functions more as a spectrum rather than dichotomous diagnosis, of which a subset can likely be safely managed nonoperatively. Copyright:
Authors: Jacob D Gire; Rolando F Roberto; Matthew Bobinski; Eric O Klineberg; Blythe Durbin-Johnson Journal: Spine J Date: 2013-02-22 Impact factor: 4.166
Authors: Kristen Radcliff; Christopher Kepler; Charles Reitman; James Harrop; Alexander Vaccaro Journal: Clin Orthop Relat Res Date: 2012-06 Impact factor: 4.176
Authors: Carlo Bellabarba; Sohail K Mirza; G Alexander West; Frederick A Mann; Andrew T Dailey; David W Newell; Jens R Chapman Journal: J Neurosurg Spine Date: 2006-06
Authors: Rinchen Phuntsok; Benjamin J Ellis; Michael R Herron; Chase W Provost; Andrew T Dailey; Douglas L Brockmeyer Journal: J Neurosurg Spine Date: 2019-02-15
Authors: M N Hadley; B C Walters; P A Grabb; N M Oyesiku; G J Przybylski; D K Resnick; T C Ryken Journal: Neurosurgery Date: 2002-03 Impact factor: 4.654
Authors: Eric M Horn; Iman Feiz-Erfan; Gregory P Lekovic; Curtis A Dickman; Volker K H Sonntag; Nicholas Theodore Journal: J Neurosurg Spine Date: 2007-02