Diagnosis and Management of Traumatic Atlanto-occipital Dislocation Injuries

Computed tomography (CT) imaging to determine the CCI (condyle-C1 interval) in pediatric patients with potential atlanto-occipital dislocation (AOD) is recommended. (Level I)

If there is clinical or radiographic suspicion of AOD, CT of the craniocervical junction is recommended. The CCI determined on CT has the highest diagnostic sensitivity and specificity for AOD among all radiodiagnostic indicators in pediatric patients. The utility of CCI in adult patients has not been reported. (Level III)

A lateral cervical radiograph is recommended for the diagnosis of AOD. If a radiological method for measurement is used to determine AOD on the lateral radiograph, the basionaxial interval-basion dental interval (BAIBDI) method is recommended. The presence of upper cervical prevertebral soft tissue swelling (STS) on an otherwise non-diagnostic plain cervical radiograph should prompt CT imaging to rule out AOD. (Level III)