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Non-operative treatment of atlanto-occipital incongruity following high energy trauma: a case report
BACKGROUND: Traumatic occipitocervical dislocations (OCDs) are rare and potentially devastating injuries, and delayed diagnosis and management is a well-known risk factor for poor outcomes in high energy trauma. Early surgical stabilization has been shown to improve outcomes and neurologic recovery...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10364009/ https://www.ncbi.nlm.nih.gov/pubmed/37492789 http://dx.doi.org/10.21037/acr-23-23 |
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author | Bunzel, Eli W. Khoo, Kevin Zhou, Haitao |
author_facet | Bunzel, Eli W. Khoo, Kevin Zhou, Haitao |
author_sort | Bunzel, Eli W. |
collection | PubMed |
description | BACKGROUND: Traumatic occipitocervical dislocations (OCDs) are rare and potentially devastating injuries, and delayed diagnosis and management is a well-known risk factor for poor outcomes in high energy trauma. Early surgical stabilization has been shown to improve outcomes and neurologic recovery in these patients. We present a case of incongruent atlanto-occipital (O-C1) joints found on post-operative computed tomography (CT) imaging following C1-C2 fusion. This patient was treated non-operatively in a cervical collar (C-collar) after traction testing revealed no dynamic instability. CASE DESCRIPTION: A 19-year-old male with history of obesity was involved in a high-speed motor vehicle collision (MVC). On arrival, he had elevated troponins but otherwise normal laboratory workup and electrocardiogram (EKG). He remained hypotensive throughout his initial presentation. A reliable neurologic exam could not be obtained due to the patient’s intubated and sedated status, however, bulbocavernosus reflex was intact, reflexes were normal and the patient did not demonstrate evidence of spinal or neurogenic shock. CT of the full spine revealed distraction of the C1-C2 articulation without associated fracture, and without clear disruption or distraction of the O-C1 joint. He was taken to the operating room for C1-C2 posterior instrumentation and fusion. Post-operative cervical spine CT revealed further distraction and subluxation of the occipitocervical junction bilaterally, with condyle to C1 interval (CCI) of 4-mm bilaterally, a basion-dens interval (BDI) of 10 mm, and a Power’s Ratio of 1.1. The patient was brought back urgently to the operating room for traction testing to rule out OCD. There was no distraction noted on dynamic traction testing, and the patient was treated non-operatively in a C-collar. At 12 weeks post-injury, the patient experienced no neck pain, and flexion/extension radiographs showed no evidence of subluxation or distraction at the O-C1 joints. CONCLUSIONS: Incongruity of the O-C1 joint may not be synonymous with instability as previously thought, and in cases of O-C1 incongruity with stable traction testing, non-operative treatment with external immobilization can be considered as a viable treatment option even in the polytraumatized patient. |
format | Online Article Text |
id | pubmed-10364009 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-103640092023-07-25 Non-operative treatment of atlanto-occipital incongruity following high energy trauma: a case report Bunzel, Eli W. Khoo, Kevin Zhou, Haitao AME Case Rep Case Report BACKGROUND: Traumatic occipitocervical dislocations (OCDs) are rare and potentially devastating injuries, and delayed diagnosis and management is a well-known risk factor for poor outcomes in high energy trauma. Early surgical stabilization has been shown to improve outcomes and neurologic recovery in these patients. We present a case of incongruent atlanto-occipital (O-C1) joints found on post-operative computed tomography (CT) imaging following C1-C2 fusion. This patient was treated non-operatively in a cervical collar (C-collar) after traction testing revealed no dynamic instability. CASE DESCRIPTION: A 19-year-old male with history of obesity was involved in a high-speed motor vehicle collision (MVC). On arrival, he had elevated troponins but otherwise normal laboratory workup and electrocardiogram (EKG). He remained hypotensive throughout his initial presentation. A reliable neurologic exam could not be obtained due to the patient’s intubated and sedated status, however, bulbocavernosus reflex was intact, reflexes were normal and the patient did not demonstrate evidence of spinal or neurogenic shock. CT of the full spine revealed distraction of the C1-C2 articulation without associated fracture, and without clear disruption or distraction of the O-C1 joint. He was taken to the operating room for C1-C2 posterior instrumentation and fusion. Post-operative cervical spine CT revealed further distraction and subluxation of the occipitocervical junction bilaterally, with condyle to C1 interval (CCI) of 4-mm bilaterally, a basion-dens interval (BDI) of 10 mm, and a Power’s Ratio of 1.1. The patient was brought back urgently to the operating room for traction testing to rule out OCD. There was no distraction noted on dynamic traction testing, and the patient was treated non-operatively in a C-collar. At 12 weeks post-injury, the patient experienced no neck pain, and flexion/extension radiographs showed no evidence of subluxation or distraction at the O-C1 joints. CONCLUSIONS: Incongruity of the O-C1 joint may not be synonymous with instability as previously thought, and in cases of O-C1 incongruity with stable traction testing, non-operative treatment with external immobilization can be considered as a viable treatment option even in the polytraumatized patient. AME Publishing Company 2023-07-18 /pmc/articles/PMC10364009/ /pubmed/37492789 http://dx.doi.org/10.21037/acr-23-23 Text en 2023 AME Case Reports. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Case Report Bunzel, Eli W. Khoo, Kevin Zhou, Haitao Non-operative treatment of atlanto-occipital incongruity following high energy trauma: a case report |
title | Non-operative treatment of atlanto-occipital incongruity following high energy trauma: a case report |
title_full | Non-operative treatment of atlanto-occipital incongruity following high energy trauma: a case report |
title_fullStr | Non-operative treatment of atlanto-occipital incongruity following high energy trauma: a case report |
title_full_unstemmed | Non-operative treatment of atlanto-occipital incongruity following high energy trauma: a case report |
title_short | Non-operative treatment of atlanto-occipital incongruity following high energy trauma: a case report |
title_sort | non-operative treatment of atlanto-occipital incongruity following high energy trauma: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10364009/ https://www.ncbi.nlm.nih.gov/pubmed/37492789 http://dx.doi.org/10.21037/acr-23-23 |
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