• Andrey Grin, Ivan Lvov, Aleksandr Talypov, Anton Kordonskiy, Ivan Godkov, Ulugbek Khushnazarov, and Vladimir Krylov.
• Department of neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia; Department of neurosurgery, Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.
• World Neurosurg. 2022 Jun 1; 162: e568e579e568-e579.

ObjectiveThe objectives of this study were to conduct a systematic review of the literature to determine the optimal treatment method for patients with atlanto-occipital dislocation (AOD) and to identify possible factors influencing their outcomes.MethodsWe conducted a systematic review of the PubMed database between January 1966 and December 2020. The main inclusion criterion was articles that discussed AOD treatment methods, and outcome descriptions were selected for analysis. Intergroup differences were assessed using nonparametric statistical methods.ResultsOf the 657 articles identified initially, only 54 met the inclusion criteria, resulting in data from 139 patients. Type I or II AODs were more frequent in patients injured in road traffic accidents, whereas type III AODs were more frequent in patients with catatrauma (P = 0.027). Spinal cord injury was more frequently observed in patients with types I and II AODs than in those with type III AOD (P = 0.026). Improved outcomes were more common in the surgical treatment group (P < 0.001). Significant differences in treatment outcomes between the halo device and orthosis groups were not observed (P = 0.32).ConclusionsPrognosis of AOD is unfavorable in adults with dislocations resulting from road traffic accidents, those with types I and II AOD, and patients younger than 22 years and older than 47 years. Surgical treatment was optimal for adult patients with an AOD, and treatment outcomes did not depend on the number of occipitocervical fusion levels. Immobilization with the halo device showed no advantages over use of an external orthosis.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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