occipitocervical dissociation

Found inside – Page 257The rule of 12 for occipitocervical dissociation. The posterior axial line (PAL) is the rostral extension of the posterior cortex of the axis body. Occipitocervical Dissociation in Three Siblings: A Pediatric Case Report and Review of the Literature. The youngest sibling, a 5-year-old boy, sustained a fatal OC dissociation. Results. Astur et al14 proposed using surgeon-supervised flexion/extension/distraction imaging with live lateral fluoroscopy when physicians are unable to assess the extent of ligamentous injury via both CT and MRI evaluation. You may be trying to access this site from a secured browser on the server. 4. Found inside – Page 134Occipitocervical dissociation, including occipitoatlantal and atlantoaxial dissociation (Fig. 5.25), and atlantoaxial rotational dissociation may also ... Posterior OC fusion is usually performed in patients with OC instability.14,17,18 Bone graft, usually harvested from the iliac crest, as was performed on patient 1, is commonly used. The proposed CT measuring techniques for the diagnosis of OC dissociation were inconsistent in our cases. Spine J. Found inside – Page 230Fracture/Dislocation. Jacob Babu Why is spinal cord injury more ... What are some radiographic parameters that help identify occipitocervical dissociation? 25. [email protected]. Atlanto occipital dissociation is a highly unstable injury which is a life threatening condition. The occiput bone is dissected up to the external EOP and laterally as far as needed to accommodate the plate. 2, 3 . J Neurosurg Spine 2007;6:113-120. Found inside – Page 538Atlantoaxial dissociation with distraction between C1 and C2 may occur with an occipitocervical dissociation or occipital condyle fractures due to ... Bellabarba C, Mirza SK, West GA, et al. Please enable scripts and reload this page. Atlanto-occipital dissociation (AOD) is an uncommon injury, with an incidence of 0.2% to 0.6%, whereby the skull is forcibly separated from the upper cervical spine due to a tremendous amount of traumatic blunt force. 18. Found inside – Page 1134Occipitocervical. Dislocation/Dissociation. Until recently, few cases of patients surviving this entity had been reported.29-31,34-36 Most reports of ... AJR Am J Roentgenol 1998;171:986. Grade I injuries have normal CT measurements, such as the Powers ratio and other previously mentioned methods, but they do have moderately abnormal findings on MRI (high posterior ligaments or edema in OC joints). Learn vocabulary, terms, and more with flashcards, games, and other study tools. Occipitocervical dissociation (OCD) occurs when this intimate connection between the cranium and the spine becomes separated or disconnected (dissociated). The association of occipitocervical dissociation and death as a result of blunt trauma. Because children are more commonly presenting with OC dissociation in the inpatient setting, physicians must be prepared to successfully manage this previously unsalvageable injury. Br J Neurosurg. They are potentially fatal (mortality rate 50-60%). Traumatic occipitocervical dislocation, also known as atlanto-occipital dislocation (AOD) or dissociation, accounts for up to 20% of fatalities during high-speed blunt trauma accidents. Kimchi G, Greenberg G, Traynelis VC, Witiw CD, Knoller N, Harel R. Integrity of the tectorial membrane is a favorable prognostic factor in atlanto-occipital dislocation. Get new journal Tables of Contents sent right to your email inbox, Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), Occipitocervical Dissociation in Three Siblings: A Pediatric Case Report and Review of the Literature, Articles in PubMed by Gabriel D. Glaun, MD, Articles in Google Scholar by Gabriel D. Glaun, MD, Other articles in this journal by Gabriel D. Glaun, MD. John C. France, MD. In light of these radiographic findings, patient 1 underwent occiput-to-C2 posterior spinal fusion with instrumentation and harvest of right iliac crest bone graft. Traumatic occipitocervical dislocation (OCD) is described in the literature as a potentially fatal injury secondary to high-energy trauma. Occipitocervical Dissociation Classification . Several classification systems have been proposed to help physicians decide between nonsurgical management and surgical fixation. Latest COVID-19 Information. Found inside – Page 32825.3.2 Occipitocervical Dissociation and Instability Occipitocervical dissociation (atlanto-occipital dislocation) involves total separation of the ... The resting osseous relationships and vertebral alignment at the time of imaging evaluation … Atlanto-occipital dislocation, orthopedic decapitation, or internal decapitation describes ligamentous separation of the spinal column from the skull base. Dr. Peleg Ben-Galim is an orthopedist in Houston, Texas. Occipitocervical dissociation is often associated with spinal cord injury, traumatic brain injury, and/or multisystem traumatic injuries. The utility and accuracy of computed tomography in the diagnosis of occipitocervical dissociation. occipitocervical dissociation can cause catastrophic neu-rologic demise. Please try again soon. To our knowledge, there is a lack of research regarding sagittal occipitocervical spine balance restoration following posterior occipitocervical fusion (POCF). The resting osseous relationships and vertebral alignment at the time of imaging evaluation may be deceivingly normal, and the . If there is a preoperative X-ray available the surgeon can use this as a guide to properly align the occipito cervical junction during fusion. Spine J 2013;13:520-522. 2013;13:510-519. It is often difficult to assess the neurologic status of these patients because they are unconscious. Globe Spine J 2015;5:505-512. The association of occipitocervical dissociation and death as a result of blunt trauma Ran Lador, Peleg J. Ben-Galim, Bradley K. Weiner , John A. Hipp Academic Institute 2016;9(3):247. Most fractures are treated with immobilization . Neither Dr. Glaun nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article. 2016, 6:529-534. Rasool MN, Govender S: Traumatic dislocation of the atlanto-occipital joint. Purpose . Conclusion: Patients with occipitocervical dissociation injuries may survive their injury and even retain neurologic integrity. Vender JR, Rekito AJ, Harrison SJ, McDonnell DE: The evolution of posterior cervical and occipitocervical fusion and instrumentation. The literature review focuses on the diagnosis of OC dissociation via CT measurements and proposed treatment recommendations using CT and MRI classification systems. Such methods include the BDI, atlanto-occipital junction width, Wackenheim line, Powers ratio, interspinous ratio, ADI, and SAC. Traumatic occipitocervical dislocation (OCD) is described in the literature as a potentially fatal injury secondary to high-energy trauma. AJR Am J Roentgenol 2009;192(1):52-58. Found inside – Page 293... Of COMPUTEd TOMOgRAPHy IN THE dIAgNOSIS Of OCCIPITOCERVICAL dISSOCIATION. ... dISLOCATION: CASE REPORT ANd LITERATURE REVIEw Of INfANT OCCIPITOCERVICAL ... Emergent surgery is required to relocate the skull to the upper cervical spine and stabilize it . This report includes three cases of occipitocervical (OC) dissociation in three siblings involved in a single, head-on, motor vehicle accident. Found inside – Page 515Occipitocervical dissociation injuries have been ment with C1-2 fusion may be necessary . Type II injuries classified as anterior type I , longitudinal type ... This requires disruption of the stabilizing intrinsic and extrinsic craniocervical junction (CCJ . Found inside – Page 958Occipitocervical dissociation must be ruled out, particularly in patients with type 3 fractures. b. Cervical orthosis B. Occipitocervical dissociation 1. Diagnosis is made using CT imaging, and if there is any doubt about the diagnosis, MRI. 61 (5): 995-1015; discussion 1015. doi:10.1227/01.neu . The drill guide is set to 8 mm (female) or 10 mm (male) and the central cranial screw hole drilled. Most common OCD abbreviation full forms updated in June 2021. Spine J 2013;13(5): 510-519 13 Pang D, Nemzek WR, Zovickian J. Atlanto-occipital dislocation: part 1—normal occipital condyle-C1 interval in 89 children. Chang W, Alexander MT, Mirvis SE. 8. Kaufman RA, Carroll CD, Buncher CR: Atlantooccipital junction: Standards for measurement in normal children. The work cannot be changed in any way or used commercially without permission from the journal. Back To Top Found insideOccipitocervical junction: imaging, pathology, instrumentation. ... and accuracy of computed tomography in the diagnosis of occipitocervical dissociation. The utility and accuracy of computed tomography in the diagnosis of occipitocervical dissociation. Recently, a revised version of the condyl-C1 interval (CCI) utilizing parasagittal computed tomography (CT) reconstruction was used successfully with unilateral dislocation of 2.5 mm at the . The diagnosis is frequently missed on initial lateral cervical spinal radiographs mainly due to inadequate visualization of radiological landmarks and . List of 273 best OCD meaning forms based on popularity. Traumatic occipitocervical dissociation (OCD) is an uncommon and fatal injury. Occipitocervical (OC) dissociation, first described by Blackwood,1 was generally considered fatal and rare throughout the last century. Of these, three cases of AOD and two cases of AAD were missed on the final report by the neuroradiologist . A delay in the diagnosis and stabilization of OC dissociation can result in secondary neurologic injury, as well as increased morbidity and mortality.11,12 With advances in imaging modalities, physicians now use several CT measurement techniques of the cervical spine, each with its own drawbacks, to identify OC dissociation. Dreiangel N(1), Ben-Galim P, Lador R, Hipp JA. Surg Neurol 1997;48:418-419. In the setting of clinically suspected OC dissociation with normal CT measurements, we recommend obtaining a cervical spine MRI to properly assess the extent of ligamentous injury. Understanding the unique anato-my, imaging, and craniometry of this area is paramount in recognizing and managing the potentially devastating . BACKGROUND CONTEXT: Despite multiple reports of survivability, dissociative occipitocervical injury . AJR Am J Roentgenol 2009;192(1):52-58. 1,2 AOD is historically considered a fatal diagnosis, but the advent of improved prehospital systems and shorter transportation . Found inside – Page 654... the patient may have an anterior occipitocervical subluxation or dislocation. FIG. ... complete occipitocervical dissociation (double-headed arrow). Collar is optional. The midline of the posterior aspect of the skull which is in line with the EOP is identified. A more recent method, the CCI, was described by Pang et al10 as having 100% sensitivity and specificity for OC dissociation. Found insideIn many such injuries ligamentous failure leads to 'occipitocervical dissociation' and fatal high cervical spinal cord injury as the result of dislocation ... Found insideOCCIPITOCERVICAL. DISSOCIATION. INJURY. PATTERNS. Injuries to the craniocervical junction can occur at a variety of locations. Atlantooccipital dislocations ... 2009;16:483-488. Wolters Kluwer Health Correspondence to Dr. Glaun: [email protected]. He received his medical degree from The Hebrew University of Jerusalem Hadassah Medical School and has been in practice for more than 20 years. The following points are generally considered as criteria for occipitocervical instability: This procedure is performed through a posterior approach with the patient placed in the prone position. The item(s) has been successfully added to ", This article has been saved into your User Account, in the Favorites area, under the new folder. Patients with occipitocervical dissociation injuries may survive their injury and even retain neurologic integrity. 3. Atlanto-occipital dissociations may account for 6% to 20% of fatal high-speed blunt trauma accidents [1]. Cranial nerve palsies often develop days or weeks after the injury. Kalani MA, Ratliff JK: Considering the diagnosis of occipitocervical dissociation. This occurrence demonstrates the inaccuracies of the various CT measuring techniques used for the diagnosis of OC dissociation. Found inside – Page 86Methods of assessing occipitocervical dissociation or dislocation from lateral radiographs: (a) calculation of Powers ratio; (b) Harris's lines; ... The utility and accuracy of computed tomography in the diagnosis of occipitocervical dissociation Jacob D. Gire, Rolando Figueroa Roberto , Matthew Bobinski , Eric Otto Klineberg , Blythe Durbin-Johnson Patients are made to sit up in the bed on the evening following the operation. Found inside – Page 447Most instances of traumatic occipitocervical dislocation are lethal and survivors may ... A ratio greater than 1 suggests possible anterior dissociation. One hundred neutral lateral cervical spine radiographs interpreted as normal were studied. MRI of the brain 5 days after the MVA revealed that the hematoma in the retroclival region was improved, with reduction in the elevation of the tectorial membrane compared with the previous study (Figure 4, B). 1 This highly unstable upper cervical spine injury is associated with mortality and morbidity as a result of respiratory arrest and quadriplegia secondary to injury to the cervicomedullary junction region. Found inside – Page 568Harris et al.27 described the rule of 12, which is superior to the Powers ratio for identifying occipitocervical dissociation. They are potentially fatal (mortality rate 50-60%). Considering the diagnosis of occipitocervical dissociation. Houle P, McDonnell DE, Vender J: Traumatic atlanto-occipital dislocation in children. Kaplan NB, Molinari C, Molinari RW: Nonoperative management of craniocervical ligamentous distraction Injury: Literature review. Her range of motion was limited because of the fusion; however, she maintained 50% of her rotation and lateral bending. However, care is taken during drilling of the lateral holes (2 and 3) as the bone will be thinner than in the midline (4 and 5). Please try after some time. Immediate diagnosis and treatment is crucial for a good outcome. Patients with OCD may present with only severe neck pain without a neurological deficit in about 20% of the cases [1]. Patients with intact neurological status are made to stand and walk on the first day after surgery. There was no evidence of severe posterior ligamentous injury. Glaun, Gabriel D. MD; Phillips, Jonathan H. MD. The patient was discharged with a neck brace in stable condition. 15. Matthew Bobinski, M.D., Ph.D. is affiliated with UC Davis Health and specializes in Radiology, Radiology - Neuroradiology and Neuroradiology in Sacramento, CA MRI of the cervical spine revealed the tectorial membrane as intact, although elevated by retroclival hematoma (Figure 4, A). to maintaining your privacy and will not share your personal information without Introduction: Atlanto-occipital dissociation (AOD) is a rare and unstable injury of the craniocervical junction, associated with very high morbidity and mortality. Registered users can save articles, searches, and manage email alerts. Initial in-line head stabilization is emphasized to prevent catastrophic neurologic injury. Of note, the CCI was also within normal limits for both of our patients. The plate is placed centered in the midline on the posterior aspect of the occiput. Historically, occipitocervical dissociation injuries have a high rate of associated neurologic deficit with a relatively high incidence of mortality. His injury was deemed a Horn grade I injury (no abnormal CT measurements and moderate MRI abnormalities revealing a retroclival hematoma without additional evidence of ligamentous injury). Chang W, Alexander MT, Mirvis SE. If in doubt, a manual fluoroscopic traction test can be performed to document stability. your express consent. To keep Some error has occurred while processing your request. What is the presentation of occipital condyle fractures? 7. Found inside – Page 46Occipital condyle fractures may be stable or represent the bony component of an occipitocervical dissociation (OCD). OCD involves disruption of the ... Traumatic occipitocervical dissociation (OCD) results from ligamentous injury to the craniocervical junction and is associated with a high rate of mortality and significant neurologic morbidity. The literature reports only a limited number of patients with OC dissociation were successfully treated nonsurgically.16 Patient 2 was successfully treated with a neck brace for 5 months, resuming normal activities thereafter. Ronald Lehman, Daniel Riew, Klaus Schnake. The utility and accuracy of computed tomography in the diagnosis of occipitocervical dissociation. As stated by the Consensus Statement of the Spine Trauma Study Group the basion-dental interval (BDI) and the basion-posterior axial line interval (BAI) rules of 12 technique (a measurement greater than 12 mm is pathologic) are the most exact, sensitive, and easy to manage for detecting and classifing occipitocervical dissociation and . J Neurosurg 2000;93(1 suppl):28-39. Found inside – Page 939Pang D, Nemzek WR, Zovickian J: Atlanto-occipital dislocation– part 2: the ... L: Radiological diagnosis of traumatic occipitocervical dissociation: 1. 800-638-3030 (within USA), 301-223-2300 (international). Computed tomography (CT) and magnetic resonance imaging (MRI) were used to diagnose severe . 16. A surgical plan involving posterior fossa . We describe a case of OCD occurring in a patient who sustained a ground-level fall whose only clinical symptom was posterior neck pain without neurologic compromise. The injuries sustained by these three siblings during the same MVA—ranging from moderate, requiring conservative management; severe, requiring surgical intervention, and fatal—further highlight the spectrum of disease observed in OC dissociation. This depends on the comfort levels and presence of other associated injuries. Sun PP, Poffenbarger GJ, Durham S, Zimmerman RA: Spectrum of occipitoatlantoaxial injury in young children. Nov 28–Dec 10, 2021, Tenderness in the posterior craniocervical transition, Dysphagia mainly in delayed presentation (glossopharyngeus, vagal, or hypoglossus nerve palsy), Hoarseness and numbness in the anterior part of the ears as well as the auditory canal (vagal nerve lesion), Torticollis or weakens in lifting the shoulders or abduction of the arm (accessory nerve damage), Deviation of the tongue (lesion of the ipsilateral hypoglossal nerve). The youngest sibling, a 5-year-old boy, sustained a fatal OC dissociation. MRI of the cervical spine revealed an evolving retroclival and anterior upper cervical epidural hematoma, as well as tectorial membrane and apical ligament disruption (Figure 2). In 2003, Steinmetz et al13 described a system using MRI to grade OC dissociation. Allograft (cortico cancellous or cortical onlay graft). 13. Traumatic occipitocervical dislocation (OCD) is an injury rarely observed [1]. : Diagnosis and treatment of craniocervical dislocation in a series of 17 consecutive survivors during an 8-year period. Those who survive an atlanto-occipital dissociation often present unconscious with sign of brain or spinal cord injury. Found insideOccipitocervical. Instability/Dissociation. Injuries to the OCJ carry significant morbidity and mortality. They are the result of high-energy trauma. Gire JD, Roberto RF, Bobinski M, et al. (2007) Neurosurgery. Chapter 65 Trauma Surgery Cervical Spine Thomas C. Chen, Charles B. Stillerman, Scott D. Daffner, L. Erik Westerlund, Alexander R. Vaccaro Injury to the cervical spine should be suspected in any patient complaining of neck pain after trauma. What does OCD abbreviation stand for? Crossref, Medline, Google Scholar; 42. Neurosurgery 2007;61:514-521, discussion 521. In cases of neurologic deficit or when decompression is indicated, the posterior arch of C1 is now removed. Traumatic atlanto-occipital dissociation (AOD) is a potentially devastating injury. Found inside – Page 756.1 Occipitocervical dislocation following car accident. Hyperintense signal on T2-weighted MRI showing blood inside C0-C1 left (a) and right (b) joints. Pediatr Neurosurg 2001;34:193-197. The screw hole is palpated to verify that the anterior cortex is still intact. Computed tomography (CT) and magnetic resonance imaging (MRI) were used to diagnose severe . 12. Gabriel D Glaun University of Central Florida College of Medicine, Orlando, FL, and Arnold Palmer Hospital for Children, the Arnold Palmer Hospital Center for Orthopedics, Orlando, FL. Shamoun JM, Riddick L, Powell RW: Atlanto-occipital subluxation/dislocation: A “survivable” injury in children. The Powers ratio, BDI, and Wackenheim line were all within normal limits. Astur N, Klimo P, Sawyer JR, Kelly DM, Muhlbauer MS, Warner WC: Traumatic atlanto-occipital dislocation in children: Evaluation, treatment, and outcomes. The future of medical education—today. Occipitocervical dissociation-incidence, evaluation, and treatment. Anterior fractures of the occipital condyles deserve scrutiny, and the potential for craniocervical dissociation should be considered . Traumatic occipitocervical dissociation (OCD) results from ligamentous injury to the craniocervical junction and is associated with a high rate of mortality and significant neurologic morbidity. Traumatic occipitocervical dissociation (OCD) results from ligamentous injury to the craniocervical junction and is associated with a high rate of mortality and significant neurologic morbidity. type I: anterior displacement type II: distraction (inferior displacement) type III: posterior displacement A limitation of this classification system is that rotatory or coronal malalignment is not . Pang D, Nemzek WR, Zovickian J. Atlanto-occipital dislocation--part 2: The clinical use of (occipital) condyle-C1 interval, comparison with other diagnostic methods, and the manifestation, management, and outcome of atlanto-occipital dislocation in children. Their application is based on the same principles and to illustrate these concepts, we will show the use of plate placed in the midline which allows for modularity and rotation when connecting to the rods. Found inside – Page 107Occipitocervical dislocation – incidence, evaluation, and treatment. ... the suspicion for atlanto-occipital dislocation (AOD, craniocervical dissociation), ...

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