Spine Surgery pp 253-267 | Cite as

Upper Cervical Spine Trauma

  • Yu-Mi RyangEmail author


Atlantooccipital dislocation (AOD) or occipitoatlantal dislocation (OAD) is a rare but serious injury of the upper c-spine caused by a traumatic ligamentous disruption of the craniocervical junction. This injury usually occurs after high-energy/-velocity accidents and is associated with a high morbidity and a mortality rate of 20–30% amongst all traumatic c-spine injuries. It can be easily overlooked but needs to be considered especially after high-impact trauma and in field resuscitation. Once deemed fatal (in earlier days only 1/3 of patients reached the hospital alive), better emergency management and the widespread availability of CTs led to better on site survival and more frequent recognition and more timely diagnosis of this injury improving mortality rates and neurological outcome. This has in consequence led to an increasing incidence of this injury.


Level of Evidence II (Diagnosis)/III (Treatment)

  1. 1.
    Theodore N, Aarabi B, Dhall SS, et al. The diagnosis and management of traumatic atlanto-occipital dislocation injuries. Neurosurgery. 2013;72(Suppl 2):114–26.CrossRefGoogle Scholar
  2. 2.
    Kandziora F, Schnake K, Hoffmann R. Injuries to the upper cervical spine. Part 1: Ligamentous injuries. Unfallchirurg. 2010;113:931–43.CrossRefGoogle Scholar
  3. 3.
    Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 1974;56:1663–74.CrossRefGoogle Scholar
  4. 4.
    Grauer JN, Shafi B, Hilibrand AS, et al. Proposal of a modified, treatment-oriented classification of odontoid fractures. Spine J. 2005;5(2):123–9.CrossRefGoogle Scholar
  5. 5.
    Ryken TC, Hadley MN, Aarabi B, et al. Management of acute combination fractures of the atlas and axis in adults. Neurosurgery. 2013;72(Suppl 2):151–8.CrossRefGoogle Scholar
  6. 6.
    Vaccaro AR, Kepler CK, Kopjar B, et al. Functional and quality-of-life outcomes in geriatric patients with type-II dens fracture. J Bone Joint Surg Am. 2013;95(8):729–35.CrossRefGoogle Scholar
  7. 7.
    Harrop JS, Hart R, Anderson PA. Optimal treatment for odontoid fractures in the elderly. Spine (Phila Pa 1976). 2010;35(21 Suppl):S219–27.CrossRefGoogle Scholar
  8. 8.
    Majercik S, Tashjian RZ, Biffl WL, et al. Halo vest immobilization in the elderly: a death sentence? J Trauma. 2005;59(2):350–6; discussion 356–8.CrossRefGoogle Scholar
  9. 9.
    Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976). 2001;26:2467–71.CrossRefGoogle Scholar
  10. 10.
    Goel A, Laheri V. Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir. 1994;129:47–53.CrossRefGoogle Scholar
  11. 11.
    Magerl F. Spondylodesis of the upper cervical spine. Acta Chir Austriaca. 1982;43(Suppl):69.Google Scholar
  12. 12.
    Käsmacher J, Schweizer C, Valentinitsch A, et al. Osteoporosis is the most important risk factor in traumatic odontoid fractures in the elderly. J Bone Miner Res. 2017;32(7):1582–8.CrossRefGoogle Scholar

Level of Evidence III

  1. 13.
    Gehweiler JA, Osborne RH, Becker RF. The radiology of vertebral trauma. Philadelphia: Saunders; 1983.Google Scholar
  2. 14.
    Dickmann CA, Greene KA, Sonntag VK. Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery. 1996;38:44–50.CrossRefGoogle Scholar
  3. 15.
    Hadley MN, Walter PC, Grabb PA, et al. Isolated fractures of the atlas in adults. In: guidelines for the management of acute cervical spine and spinal cord injuries. Neurosurgery. 2002;50(3 suppl):S120–4.Google Scholar
  4. 16.
    Ryken TC, Aarabi B, Dhall SS, et al. Management of isolated fractures of the atlas in adults. Neurosurgery. 2013;72(Suppl 2):127–31.CrossRefGoogle Scholar
  5. 17.
    Kandziora F, Schnake K, Hoffmann R. Injuries to the upper cervical spine. Part 2: Osseous injuries. Unfallchirurg. 2010;113:1023–41.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany

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