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. 2021 Jan;37(1):177-183.
doi: 10.1007/s00381-020-04680-w. Epub 2020 Jun 9.

Traumatic atlanto-occipital dislocation in children: is external immobilization an option?

Taylor J Abel  1   2 , Han Yan  3 , Michael Canty  3 , Madison Remick  4 , Michael Dewan  4 , Christopher Witiw  3 , Maria Lamberti-Pasculi  3 , James M Drake  3
Affiliations

Traumatic atlanto-occipital dislocation in children: is external immobilization an option?

Taylor J Abel et al. Childs Nerv Syst. 2021 Jan.

Abstract

Object: Traumatic atlanto-occipital dislocation (AOD) is a relatively uncommon traumatic cervical spine injury characterized by disruption and instability of the atlanto-occipital joint. At many centers, management of pediatric AOD includes occipitocervical arthrodesis, but whether external immobilization without surgery is a viable treatment option for some pediatric patients is unknown. To answer this question, we analyzed our outcomes of pediatric AOD at the Hospital for Sick Children.

Methods: We performed a retrospective chart review of all children with clinical and radiographic evidence of traumatic AOD. A total of 10 patients met criteria for traumatic AOD: 8 were treated with external immobilization alone and 2 were treated with occipitocervical arthrodesis.

Results: Eight patients were treated exclusively with 3 months of halo immobilization. Two patients were treated with occipitocervical instrumentation and arthrodesis. No patient undergoing halo immobilization required subsequent operative fusion.

Conclusion: Halo immobilization is a safe, viable, and definitive treatment option for the selected children with AOD.

Keywords: Atlanto-occipital dissociation; Motor vehicle collisions; Pediatric neurosurgery; Spine; Trauma.

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