Traumatic atlanto-occipital dislocation with atlantoaxial subluxation

STUDY DESIGN. This is a case report of a patient who survived traumatic atlanto-occipital dislocation with atlantoaxial subluxation. OBJECTIVE. To describe the useful points of 3-dimensional computerized tomography (CT) and magnetic resonance imaging (MRI) for an evaluation of atlanto-occipital dislocation. SUMMARY OF BACKGROUND DATA. Atlanto-occipital dislocation is a severe ligamentous injury that usually results in either a fatal outcome or severe neurologic deficit. To our knowledge, no patient who has survived atlanto-occipital dislocation with atlantoaxial subluxation has yet been reported. METHODS. Three-dimensional CT was performed to confirm the diagnosis of atlanto-occipital dislocation and precisely evaluate the magnitude of displacement. MRI clearly showed a disruption of the ligamentous structures, which play a role as the primary stabilizers of the cranium on the cervical spine. RESULTS. As soon as the patient's general condition improved, the posterior spinal fusion with internal fixation was performed to maintain the stability of cervical spine. A significant degree of motor function was regained within 2 years after injury. CONCLUSIONS. In this case, the diagnosis was accurately confirmed, and the cervical spine was evaluated in detail using both 3-dimensional CT and MRI as a reliable examination for atlanto-occipital dislocation.