Last updated January 6, 2022

Diagnosis and Management of Traumatic Atlanto-occipital Dislocation Injuries

RECOMMENDATIONS

Diagnostic

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

Treatment with internal fixation and fusion using one of a variety of methods is recommended. (Level III)
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Traction is not recommended in the management of patients with AOD, and is associated with a 10% risk of neurological deterioration. (Level III)
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Recommendation Grading

Overview

Title

Diagnosis and Management of Traumatic Atlanto-occipital Dislocation Injuries

Authoring Organization

Publication Month/Year

March 1, 2013

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The purpose of the current review is to update the medical evidence on the diagnosis and treatment of atlanto-occipital dislocation since that early publication. 

Target Patient Population

Patients with atlanto-occipital dislocation

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Outpatient

Scope

Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D001269 - Atlanto-Occipital Joint, D009493 - Neurosurgery, D019635 - Neurosurgical Procedures

Keywords

atlanto-occipital dislocation, cranio-cervical instability, dislocation

Source Citation

Neurosurgery, Volume 72, Issue suppl_3, March 2013, Pages 114–126, https://doi-org.ezproxylocal.library.nova.edu/10.1227/NEU.0b013e31827765e0