Atlanto-occipital distraction injuries in survivors: craniometrics and associated ligamentous, spinal cord, and blunt cerebrovascular injury

Abstract

Purpose

Newer classification systems for upper cervical spine trauma now include ligamentous injury in addition to fracture and dislocation patterns. Assessment of associated ligamentous injury, spinal cord injury (SCI), and blunt cerebrovascular injuries (BCVI) in patients with atlanto-occipital distraction injuries (AODI) are critical for management. We aim to determine the incidence of ligamentous injury, SCI, and BCVI in patients with AODI and assess how craniometrics perform in diagnosis of AODI.

Materials and methods

We performed an IRB-approved retrospective analysis of 35 cases of diagnosed AODI over a period of 8 years. Imaging was analyzed by two experienced neuroradiologists for craniometric measurements, ligamentous injury, SCI, and BCVI. Craniometric measurements were compared to 35 age-matched controls with normal atlanto-occipital joint.

Results

Out of 35 patients diagnosed with AODI, 27 were adults and 8 belonged to pediatric age group. The mean age of presentation was 29.4 years with a male/female ratio of 22:13. The basion-dental interval (70.4%) and the combined condylar sum (74.1%) were the most sensitive craniometric measurements for diagnosis of AODI. Alar ligament (83%) and the tectorial membrane (89%) injuries were most commonly injured ligaments. Three adult patients sustained SCI and 10 patients had BCVI. Majority of BCVI involved the internal carotid artery followed by the vertebral artery.

Conclusions

The combination of craniometric indices with assessment of ligamentous injuries provides higher diagnostic accuracy for AODI. Alar ligament and tectorial membrane injuries have high association with AODI. There is high association of SCI and BCVI in AODI survivors.

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Data Availability

Available.

Abbreviations

AODI:

Atlanto-occipital dissociation injuries

SCI:

Spinal cord injury

BCVI:

Blunt cerebrovascular injury

NECT:

Non-enhanced CT

T2W:

T2-weighted

T1W:

T1-weighted

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Correspondence to Roy F. Riascos.

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Khanpara, S.D., McCarty, J.L., Schmitt, K.M. et al. Atlanto-occipital distraction injuries in survivors: craniometrics and associated ligamentous, spinal cord, and blunt cerebrovascular injury. Emerg Radiol (2020). https://doi.org/10.1007/s10140-020-01827-9

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Keywords

  • Atlanto-occipital distraction injuries
  • craniocervical ligament injury
  • craniometric indices
  • spinal cord injury
  • blunt cerebrovascular injury