Survival After Concurrent Traumatic Dislocation of the Atlanto-Occipital and Atlanto-Axial Joints

STUDY DESIGN: A case report of a patient who survived a traumatic disassociation of both atlanto-occipital and atlantoaxial joints. OBJECTIVE.: To describe a rare case of concurrent atlanto-occipital and atlantoaxial dislocation with a review of the related literature regarding occipitocervical dislocation. SUMMARY OF BACKGROUND DATA: Cases of isolated atlanto-occipital or atlantoaxial dislocation have typically resulted in death or devastating neurologic deficit. Survival after the simultaneous dislocation at both joints is extremely rare. METHODS: The initial evaluation, subsequent management, and surgical treatment of a 25-year-old male who sustained a concurrent dislocation of the atlantoaxial and atlanto-occipital joints from a motor vehicle collision are reported and the related literature is discussed. RESULTS: The patient was transferred to our hospital after initial stabilization according to Emergency Medical Service criteria and management based on the Advanced Trauma Life Support protocol. A complete (ASIA A) spinal cord injury was diagnosed on admission. Radiographic evaluation revealed dislocations of the atlanto-occipital and atlantoaxial joints. Subsequently, the patient underwent surgical stabilization with instrumented posterior fusion from the occiput to C5. Intraoperatively, traumatic pseudomeningocele was diagnosed and repaired with pericranial autograft. The vital function parameters currently remain stable, but the patient is ventilator-dependent and did not regain motor or sensory function. CONCLUSION: The rapid response time of emergency medical services and stabilization according to the Advanced Trauma Life Support protocol now lead to the survival of patients with significant deficit from occipitocervical injuries. A high index of suspicion is required to appropriately manage a patient with this devastating injury in order to maximize the chance for survival.