Jordan Stav[/caption]

Despite AOD having extremely high mortality and morbidity, there have been increasing reports of AOD survivors.¹ The decrease in morbidity and mortality may be due to the advents of prehospital care as well as the early recognition and treatment in the emergency department, which has been associated with the establishment and development of emergency medicine as a specialty.^1–3

The earlier the patient is put in C-spine stabilization and advanced imaging is performed—often with CT, then MRI—the greater the probability of improved morbidity and mortality.⁴ Following external stabilization and diagnosis, early and aggressive surgical stabilization is associated with improved outcomes.⁵

Due to the decrease in mortality, AOD may become a more frequent diagnosis in the emergency department. It is important that we keep C-spine injuries at the forefront of our minds while evaluating trauma patients. This entails maintaining C-spine precautions during procedures and transport of these patients.

Case Resolution

This patient was taken to the operating room for emergent neurosurgical intervention following her MRI findings (See Figure 2). Her occiput was fused to C2. The patient was subsequently successfully extubated and discharged home six days after her surgery. She was able to walk out of the hospital under her own strength and has had an uneventful recovery to date. 

Dr. Stav is a PGY3 emergency medicine resident at Ascension Macomb-Oakland Hospital in Warren, Michigan. DR. KOPP, DR. MA, and DR. DAOUK are emergency physicians at Ascension St. John Hospital in Detroit.

References

1. Ehlinger M, Charles YP, Adam P, et al. Survivor of a traumatic atlanto-occipital dislocation. Orthop Traumatol Surg Res. 2011;97(3):335-340.
2. Hall GC, Kinsman MJ, Nazar RG, et al. Atlanto-occipital dislocation. World J Orthop. 2015;6(2):236-243.
3. Garrett M, Consiglieri G, Kakarla UK, et al. Occipitoatlantal dislocation. Neurosurgery. 2010;66(3 Suppl):48-55.
4. Saeheng S, Phuenpathom N. Traumatic occipitoatlantal dislocation. Surg Neurol. 2001;55(1):35-40; discussion 40.
5. Hadley MN, Walters BC, Grabb PA, et al. Diagnosis and management of traumatic atlanto-occipital dislocation injuries. Neurosurgery. 2002;50(3 Suppl):S105-113.