Combined occipital-cervical and atlantoaxial disassociation without neurologic injury: Case report and review of the literature

Erica Bisson, Alison Schiffern, Michael D. Daubs, Darrel S. Brodke, Alpesh A. Patel

Research output: Contribution to journalReview articlepeer-review

16 Scopus citations

Abstract

STUDY DESIGN.: Case report and literature review. OBJECTIVE.: To discuss the diagnosis, limitations, and treatment of combined occipital-cervical and atlantoaxial disassociation with normal neurologic function. SUMMARY OF BACKGROUND DATA.: Injuries to the craniocervical junction can lead to devastating neurologic deficits. Occipital-cervical disassociation is a well-documented injury pattern that can lead to pain, spinal cord injury, and death. Early diagnosis and treatment can preserve neurologic function. Combined injuries to both the occipital-cervical and atlantoaxial segments are less common and, to date, have only been described with severe neurologic injury. METHODS.: Retrospective review of a case. Literature review was performed through Medline and Pubmed searches. RESULTS.: This is the first case to present a combined occipital-cervical and atlantoaxial disassociation with a neurologically intact patient. Initial physical examination was limited, but early imaging revealed evidence of instability. Early diagnosis and early (<24) surgical stabilization was performed with no complications and neurologic preservation. One-year follow-up visit revealed normal neurologic examination with neck pain VAS = 2/10 and neck disability index = 6. CONCLUSION.: Combined injuries to the occipital-cervical and atlantoaxial can result in upper cervical instability. Despite previous reports, neurologic preservation remains a possibility in this injury pattern. Limitations in physical examination and radiographic imaging persist, but early diagnosis and surgical stabilization may improve neurologic outcomes.

Original languageEnglish (US)
JournalSpine
Volume35
Issue number8
DOIs
StatePublished - Apr 1 2010

Keywords

  • Atlantoaxial disassociation
  • Combined injury
  • Diagnosis
  • Neurologic preservation
  • Occipital-cervical disassociation
  • Outcomes
  • Treatment

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

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