Timely recognition of traumatic atlanto-occipital dislocation in a child based on occipital condyle–C1 interval analysis: excellent neurological recovery

Abstract

A case of atlanto-occipital dislocation (AOD) is presented to illustrate the importance of subtle imaging findings and the occipital condyle–C1 interval (CCI) measurement in the evaluation of high cervical spine injury. Although AOD is commonly considered to be fatal, recently there have been an increasing number of reports of children surviving this injury. Prompt recognition and treatment of AOD are crucial for survival. The authors present a case of an 8-year-old boy who sustained a destabilizing injury without bone disruption but with ligamentous tears that rendered his cervical spine unstable from the occiput to the C-1 level. On admission, imaging findings were consistent with tectorial membrane damage, perimedullary subarachnoid hemorrhage, and extraaxial blood from the clivus to the C-2 level. Most standard cervical spine radiological indices were within normal limits except the CCI. After initial management in a cervical collar, the patient was placed in halo vest, and subsequently underwent occiput to C-3 fusion. Timely recognition of the injury and subsequent craniocervical stabilization with internal fixation resulted in full neurological recovery. This report supports CCI as a valuable index for the prompt recognition of AOD. It also supports recent literature suggesting that AOD is a survivable injury with the possibility for an excellent neurological recovery.