PMID- 35854957
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220721
IS  - 2694-1902 (Electronic)
IS  - 2694-1902 (Linking)
VI  - 2
IP  - 1
DP  - 2021 Jul 5
TI  - Occipitocervical fusion of traumatic atlanto-occipital dissociation in a patient 
      with autofused cervical facet joints: illustrative case.
PG  - CASE21276
LID - 10.3171/CASE21276 [doi]
LID - CASE21276
AB  - BACKGROUND: Patients who survive traumatic atlanto-occipital dissociation (AOD) 
      may present with normal neurological examinations and near-normal-appearing 
      diagnostic images, such as cervical radiographs and computed tomography (CT) 
      scans. OBSERVATIONS: The authors described a neurologically intact 64-year-old 
      female patient with a degenerative autofusion of her right C4-5 facet joints who 
      presented to their center after a motor vehicle collision. Prevertebral soft 
      tissue swelling and craniocervical subarachnoid hemorrhage prompted awareness and 
      consideration for traumatic AOD. An abnormal occipital condyle-C1 interval (4.67 
      mm) on CT and craniocervical junction ligamentous injury on magnetic resonance 
      imaging (MRI) confirmed the diagnosis of AOD. Her autofused right C4-5 facet 
      joints were incorporated into the occipitocervical fusion construct. LESSONS: 
      Traumatic AOD can be easily overlooked in patients with a normal neurological 
      examination and no associated upper cervical spine fractures. A high index of 
      suspicion is needed when evaluating CT scans because normal values for 
      craniocervical parameters are significantly different from the accepted ranges of 
      normal on radiographs in the adult population. MRI of the cervical spine is 
      helpful to evaluate for atlanto-occipital ligamentous injury and confirm the 
      diagnosis. Occipitocervical fusion construct may need to be extended to 
      incorporate spinal levels with degenerative autofusion to prevent adjacent level 
      degeneration.
CI  - (c) 2021 The authors.
FAU - Sarmiento, J Manuel
AU  - Sarmiento JM
AD  - Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California.
FAU - Chang, Daniel
AU  - Chang D
AD  - Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California.
FAU - Nisson, Peyton L
AU  - Nisson PL
AD  - Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California.
FAU - Chan, Julie L
AU  - Chan JL
AD  - Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California.
FAU - Perry, Tiffany G
AU  - Perry TG
AD  - Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California.
LA  - eng
PT  - Case Reports
DEP - 20210705
PL  - United States
TA  - J Neurosurg Case Lessons
JT  - Journal of neurosurgery. Case lessons
JID - 9918227275606676
PMC - PMC9272367
OTO - NOTNLM
OT  - AOD = atlanto-occipital dissociation
OT  - BAI = basion-axial interval
OT  - BDI = basion-dens interval
OT  - CCI = condyle-C1 interval
OT  - CT = computed tomography
OT  - MRI = magnetic resonance imaging
OT  - PAL = posterior axial line
OT  - STIR = short tau inversion recovery
OT  - atlanto-occipital dislocation
OT  - atlanto-occipital dissociation
OT  - degenerative facet fusion
OT  - facet joint autofusion
OT  - occipitocervical fusion
COIS- Disclosures The authors report no conflict of interest concerning the materials 
      or methods used in this study or the findings specified in this paper.
EDAT- 2022/07/21 06:00
MHDA- 2022/07/21 06:01
PMCR- 2021/07/05
CRDT- 2022/07/20 02:08
PHST- 2021/05/04 00:00 [received]
PHST- 2021/05/24 00:00 [accepted]
PHST- 2022/07/20 02:08 [entrez]
PHST- 2022/07/21 06:00 [pubmed]
PHST- 2022/07/21 06:01 [medline]
PHST- 2021/07/05 00:00 [pmc-release]
AID - CASE21276 [pii]
AID - 10.3171/CASE21276 [doi]
PST - epublish
SO  - J Neurosurg Case Lessons. 2021 Jul 5;2(1):CASE21276. doi: 10.3171/CASE21276. 
      eCollection 2021 Jul 5.