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

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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.

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Authors and Affiliations

  1. Division of Neurosurgery, The Hospital for Sick Children, Toronto, Canada

    Taylor J. Abel, Han Yan, Michael Canty, Christopher Witiw, Maria Lamberti-Pasculi & James M. Drake

  2. Department of Neurological Surgery, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Taylor J. Abel, Madison Remick & Michael Dewan

Authors
  1. Taylor J. Abel
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  2. Han Yan
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  3. Michael Canty
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  4. Madison Remick
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  5. Michael Dewan
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  6. Christopher Witiw
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  7. Maria Lamberti-Pasculi
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  8. James M. Drake
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Corresponding author

Correspondence to Taylor J. Abel.

Ethics declarations

In compliance with the Research Ethics Board at the Hospital for Sick Children, we reviewed clinical records of children, between zero and 17 years of age, who were diagnosed with traumatic AOD and treated over a 16-year time period from 2002 to 2018.

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The authors have no conflicts of interest to disclose.

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Abel, T.J., Yan, H., Canty, M. et al. Traumatic atlanto-occipital dislocation in children: is external immobilization an option?. Childs Nerv Syst 37, 177–183 (2021). https://doi.org/10.1007/s00381-020-04680-w

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  • DOI: https://doi.org/10.1007/s00381-020-04680-w

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