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World J Orthop. Mar 18, 2015; 6(2): 236-243
Published online Mar 18, 2015. doi: 10.5312/wjo.v6.i2.236
Atlanto-occipital dislocation
Graham C Hall, Michael J Kinsman, Ryan G Nazar, Rob T Hruska, Kevin J Mansfield, Maxwell Boakye, Ralph Rahme
Graham C Hall, Michael J Kinsman, Ryan G Nazar, Rob T Hruska, Kevin J Mansfield, Maxwell Boakye, Ralph Rahme, Department of Neurosurgery, University of Louisville, Louisville, KY 40241, United States
Ralph Rahme, Inova Neuroscience Institute, Falls Church, VA 22042, United States
Author contributions: Hall GC, Kinsman MJ, Nazar RG, Hruska RT and Mansfield KJ performed the literature review, wrote the preliminary draft of the manuscript and revised the paper; Rahme R and Boakye M conceived and supervised the project and critically reviewed the draft; all authors approved the final submitted version of the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ralph Rahme, MD, Inova Neuroscience Institute, 3300 Gallows Rd, Falls Church, VA 22042, United States. rrahme@waln.org
Telephone: +1-703-7764023 Fax: +1-703-7764018
Received: February 14, 2014
Peer-review started: February 14, 2014
First decision: March 12, 2014
Revised: October 11, 2014
Accepted: October 23, 2014
Article in press: October 27, 2014
Published online: March 18, 2015
Abstract

Atlanto-occipital dislocation (AOD) is being increasingly recognized as a potentially survivable injury as a result of improved prehospital management of polytrauma patients and increased awareness of this entity, leading to earlier diagnosis and more aggressive treatment. However, despite overall improved outcomes, AOD is still associated with significant morbidity and mortality. The purpose of this paper is to review the biomechanical aspects, clinical features, radiologic criteria, and treatment strategies of AOD. Given that the diagnosis of AOD can be very challenging, a high degree of clinical suspicion is essential to ensure timely recognition and treatment, thus preventing neurological decline or death.

Keywords: Atlanto-occipital dislocation, Cervical spine, Craniocervical junction, Occipitocervical fusion, Trauma

Core tip: Atlanto-occipital dislocation (AOD) is being increasingly recognized as a potentially survivable injury as a result of improved prehospital management, increased awareness, and more aggressive management. However, despite overall improved outcomes, AOD is still associated with significant morbidity and mortality. Given that the diagnosis can be very challenging, a high degree of clinical suspicion is essential to ensure timely recognition and treatment, thus preventing neurological decline or death.