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Traumatische atlantookzipitale Dissoziation im Rahmen einer Komplexverletzung der HWS

Fallbeschreibung bei einem 12-jährigen Kind

Traumatic atlanto-occipital dislocation as part of a complex cervical spine injury

Case report in a 12-year-old girl

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Zusammenfassung

Die atlantookzipitale Dissoziation (AOD) ist eine seltene Verletzung der HWS mit meist letalem Ausgang. Obwohl die AOD Ursache für 10% der tödlich verlaufenden HWS-Verletzungen ist, wurden in den letzten Jahren zunehmend Fälle dokumentiert, bei denen eine AOD überlebt wurde. Ursachen hierfür sind eine verbesserte Notfallversorgung mit routinemäßiger HWS-Stabilisierung entsprechend der ATLS-Guidelines, eine frühzeitige Diagnosestellung durch eine verbesserte Bildgebung im Rahmen des Ganzkörper-Spiral-CT bei der Versorgung von Polytraumata sowie die prompte Behandlung durch Reposition und adäquate Immobilisierung. Wir berichten über den Fall eines 12-jährigen Mädchens, das eine AOD mit begleitender Translationsverletzung C6/7 mit einseitig verhakter Facettengelenkluxation überlebt hat. Nach primär konservativem Therapieversuch erfolgte die sekundäre navigierte dorsale Spondylodese C0 auf C1 mittels CerviFix® sowie die Reposition der Subluxation C6/C7 und die ebenfalls navigierte Stabilisierung mittels Laminahaken. Anhand dieses Beispiels wurden die bisher zu diesem Thema publizierte Literatur zu Diagnosestellung, Management und Prognose aufgearbeitet.

Abstract

Traumatic atlanto-occipital dislocation (AOD) appears to be an unusual and almost universally fatal injury. Although AOD is the cause of death in about 10% of fatal cervical spine injuries an increasing number of reports document cases of survival following this injury. Improved pre-hospital and in-hospital emergency care according to ATLS guidelines that include early cervical spine stabilization, effective diagnosis because of improved imaging after trauma including whole body multislice CT followed by expeditious reposition and adequate immobilization are reasons for this phenomenon. We report the case of a 12-year-old girl surviving an AOD accompanied by a distraction injury C6/7 with unilateral fixed spinal luxation. After a primary attempt at closed reduction and external stabilization with a halo vest, the injury was treated by a navigated dorsal spondylodesis C0-C1 using the CerviFix rod system and open reposition of the remaining subluxation C6/7 with laminar hooks. The literature was reviewed for diagnostic possibilities, management and prognosis of AOD.

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  1. Department für Orthopädie und Traumatologie, Albert-Ludwigs-Universität, Hugstetter Straße 55, 79106, Freiburg, Deutschland

    H. Schmal, N.P. Südkamp & M. Oberst

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  1. H. Schmal
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  2. N.P. Südkamp
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  3. M. Oberst
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Correspondence to H. Schmal.

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Schmal, H., Südkamp, N. & Oberst, M. Traumatische atlantookzipitale Dissoziation im Rahmen einer Komplexverletzung der HWS. Unfallchirurg 110, 720–725 (2007). https://doi.org/10.1007/s00113-007-1262-2

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