The spine journal : official journal of the North American Spine Society | 2021
Analysis of diagnostics, therapy and outcome of patients with traumatic atlanto-occipital dislocation.
Abstract
BACKGROUND CONTEXT\nPatients outcome following traumatic atlanto-occipital dislocation (AOD) has been poor. In recent years, an increasing number of patients surviving the initial trauma are admitted to hospital. In order to further improve the management of these patients, the knowledge of diagnostics and therapy as well as possible complications should be increased.\n\n\nPURRPOSE\nThe aim of this study was to evaluate diagnostic parameters, therapy, early complications and outcome of patients with traumatic AOD.\n\n\nSTUDY DESIGN\nMonocentric retrospective cohort study.\n\n\nPATIENT SAMPLE\nA total of twelve patients were included in this study.\n\n\nOUTCOME MEASURES\nThe main outcome measure was functional patient outcome. Furthermore, radiographic and treatment data were analyzed.\n\n\nMETHODS\nAll patients suffering from traumatic AOD within an eight-year time period were included. Demographic data, radiological diagnostic parameters (condylar sum, basion dens interval, basion axis interval, power´s ratio, x-line method), as well as treatment data and complications of every patient were analyzed. Radiological parameters were compared with each other. Outcome was analyzed by a follow up examination.\n\n\nRESULTS\nThe accident mechanisms were motor vehicle accidents (MVA), fall from high and low height. Basion dens interval, basion axis interval, power s ratio and x-line method were not reliable in identifying traumatic AOD (only up to 33% of the patients were identified). Twelve patients could be reviewed. Three patients were treated with surgery, five patients were treated non-surgically. Four patients died before surgical therapy. All seven surviving patients (survival rate: 58.3%) were re-examined (mean follow-up time: 6.7 months). All patients had a GCS of 15. Three surviving patients suffered from persisting neurological deficits.\n\n\nCONCLUSIONS\nThe most reliable way to diagnose AOD in Computer Topography is using the condylar sum. Surgical and non-surgical measures can be employed with reasonable outcomes. Patient specific injury burden and clinical presentation should be taken into account when making treatment decisions for AOD.