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Rebirth on the operating table: How can a patient reverse the fatal consequences of cervical dislocation?
Atlanto-occipital dislocation, also known as orthopedic decapitation or internal decapitation, describes a separation of the ligaments between the spine and the base of the skull. Although survival is possible, the mortality rate for this type of injury is as high as 70%, and most patients die immediately after the accident. However, some patients miraculously reverse this fatal consequence and return to normal life.
The stories of these patients are not only stories of medical miracles, but also stories of human resilience and the will to survive.
These injuries are often caused by high-speed traffic accidents, especially in children because their heads are larger in proportion to their bodies. Therefore, they are more susceptible to such injuries when a violent impact occurs. The connection between the neck and the cervical spine is particularly important, especially the "C1" spine. As the main structure supporting the head, any damage to it may severely affect the individual's physiological functions.
Diagnostic Process
The first step in confirming the diagnosis is usually based on history and physical examination, followed by confirmation through imaging studies. CT scans are the first choice for acute trauma patients because of their rapidity. The medical team will assess the integrity of the intramedullary structures and their proximity to surrounding tissues, based on the integrity of the ligaments. For example, for the distance between "dens" and "basion" (i.e. BDI), the normal value should be less than 9 mm.
Measurement methods such as the "Wackenheim line" can also help determine the condition of the joints. If the line intersects with the "dens", you need to be alert and conduct further inspections. In addition, the normal value of the "atlanto-occipital interval" should be within 4 mm, which helps to assess whether there are other potential injuries.
Treatment Options
Treatment usually involves fixing the cervical spine to the base of the skull, a procedure called craniospinal fusion, using tools such as a lateral median rod and cross-linked screws. Although such surgery can provide the necessary stability, the patient may not be able to turn the head back and forth in a horizontal direction. Brain edema may be found during surgery, in which case the doctor will perform appropriate drainage.
But not all patients can successfully survive the operation, and the patient's survival rate is proportional to the severity of the injury and its response.
Prognosis and chance of survival
Among these injuries, 70% of patients die immediately, and another 15% of patients, although sent to the emergency room, will still die during hospitalization. The chance of survival depends greatly on the extent of the injury, especially as measured by the "basion-dental interval". If this value is greater than 16 mm, the risk of death increases significantly.
It is worth noting that after experiencing such injuries, many patients may face significant neurological impairment, including reversible or irreversible quadriplegia, multiple cranial nerve deficits, and even loss of consciousness. Thankfully, in some cases, patients are able to achieve a near-complete recovery, which provides some hope.
Relationship with other cervical spine injuries
Cervical fractures are closely related to cervical dislocations, the most common of which include "Jefferson fracture" and "Hangman's fracture". The presence of these injuries not only complicates treatment, but also poses further challenges to prognosis. .
Cultural influenceA clear understanding of how these injuries are related is critical to developing appropriate treatment plans.
Extreme versions of these injuries have also appeared in popular culture, such as in Michael Connelly’s 2020 thriller Fair Warning, where the protagonist Jack McEvoy investigates a case of cervical dislocation and uncovers a serial killer. crime. In addition, many medical dramas have explored related surgical procedures, making more people aware of this type of injury.
Behind every injury lies the fragility and tenacity of human beings. When facing the test of life and death, how should we view the value of life and hope in adversity?
