Diagnosis and treatment of craniocervical dislocation in a series of 17 consecutive survivors during an 8-year period

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Publication Type Journal Article
School or College School of Medicine
Department Neurosurgery
Creator Dailey, Andrew T.
Other Author Bellabarba, Carlo; Mirza, Sohail K.; West, G. Alexander; Mann, Frederick A.; Newell, David W.; Chapman, Jens R.
Title Diagnosis and treatment of craniocervical dislocation in a series of 17 consecutive survivors during an 8-year period
Date 2006
Description Object. Craniocervical dissociation (CCD) is a highly unstable and usually fatal injury resulting from osseoligamentous disruption between the occiput and C-2. The purpose of this study was to elucidate systematic factors associated with delays in diagnosing and treating this life-threatening condition and to introduce an injury-severity classification with therapeutic implications. Methods. In a retrospective evaluation of institutional databases, the authors reviewed medical records and original images obtained in 17 consecutive surviving patients with CCD treated between 1994 and 2002. Images and clinical results of treatment were evaluated, emphasizing the timing of diagnosis, clinical effect of delayed diagnosis, potential clinical or imaging warning signs, and response to treatment. Craniocervical dissociation was identified or suspected on the initial lateral cervical spine radiograph acquired in two patients (12%) and was diagnosed based on screening computerized tomography findings in two additional patients (12%). A retrospective review of initial lateral x-ray films showed an abnormal dens-basion interval in 16 patients (94%). The 2-day average delay in diagnosis was associated with profound neurological deterioration in five patients (29%). Neurological status declined in one patient after a fixation procedure was performed. There were no cases of craniocervical pseudarthrosis or hardware failure during a mean 26-month follow-up period. The mean American Spinal Injury Association (ASIA) motor score of 50 improved to 79, and the number of patients with useful motor function (ASIA Grade D or E) increased from seven (41%) preoperatively to 13 (76%) postoperatively. Conclusions. The diagnosis of CCD was frequently delayed, and the delay was associated with an increased likelihood of neurological deterioration. Early diagnosis and spinal stabilization protected against worsening spinal cord injury.
Type Text
Publisher American Association of Neurological Surgeons (AANS)
Volume 4
Issue 6
First Page 429
Last Page 440
Subject Spinal cord injury; Craniocervical dislocation; Atlantooccipital joint; Atlantoaxial joint; Tetraplegia; CCJ; CCD
Subject LCSH Spinal cord -- Wounds and injuries; Atlanto-occipital joint; Quadriplegia
Language eng
Bibliographic Citation Bellabarba, C., Mirza, S. K., West, G. A., Mann, F. A., Dailey, A. T., Newell, D. W., & Chapman, J. R. (2006). Diagnosis and treatment of craniocervical dislocation in a series of 17 consecutive survivors during an 8-year period. Journal of Neurosurgery: Spine, 4(6), 429-40.
Rights Management (c) American Association of Neurological Surgeons
Format Medium application/pdf
Format Extent 852,692 bytes
Identifier ir-main,13220
ARK ark:/87278/s6s760vj
Setname ir_uspace
Date Created 2012-06-13
Date Modified 2012-06-13
ID 706505
Reference URL https://collections.lib.utah.edu/ark:/87278/s6s760vj
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