• Neurosurgery · Feb 2020

    Review

    Diagnosis and management of traumatic atlanto-occipital dislocation injuries.

    • M N Hadley, B C Walters, P A Grabb, N M Oyesiku, G J Przybylski, D K Resnick, and T C Ryken.
    • Neurosurgery. 2020 Feb 3; 50 (3 Suppl): S105-13.

    DiagnosticStandardsThere is insufficient evidence to support diagnostic standards.GuidelinesThere is insufficient evidence to support diagnostic guidelines.OptionsA lateral cervical x-ray is recommended for the diagnosis of atlanto-occipital dislocation. If a radiological method for measurement is used, the basion-axial interval-basion-dental interval method is recommended. The presence of upper cervical prevertebral soft tissue swelling on an otherwise nondiagnostic plain x-ray should prompt additional imaging. If there is clinical suspicion of atlanto-occipital dislocation, and plain x-rays are nondiagnostic, computed tomography or magnetic resonance imaging is recommended, particularly for the diagnosis of non-Type II dislocations.TreatmentStandardsThere is insufficient evidence to support treatment standards.GuidelinesThere is insufficient evidence to support treatment guidelines.OptionsTreatment with internal fixation and arthrodesis using one of a variety of methods is recommended. Traction may be used in the management of patients with atlanto-occipital dislocation, but it is associated with a 10% risk of neurological deterioration.

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