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Article Details

Case Report
Volume 3, Issue 1 (February Issue)

Purely Ligamentous Combined Atlanto-Occipital and Atlanto-Axial Dissociation

Mitchell K Long1, Matthew G Alben2, Maksim Vaysman1* and Dante Leven1

1Department of Orthopedic Surgery, Nassau University Medical Center, East Meadow, New York
2New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, New York

*Corresponding author: Maksim Vaysman, Department of Orthopedic Surgery, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, New York, USA.

Received: July 27, 2023; Accepted: August 18, 2023; Published: August 29, 2023

Citation: Long MK, Alben MG, Vaysman M, Leven D. Purely Ligamentous Combined Atlanto-Occipital and Atlanto-Axial Dissociation. Case Rep Orthop Surg J. 2023; 2(3): 121.

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Abstract

Craniocervical dissociation is typically a fatal condition that occurs secondary to a high-energy trauma, most commonly MVA’s, auto-pedestrian accidents, and falls from elevated heights. Disruption of the internal and external ligamentous stabilizers of the upper cervical spine predisposes to chronic neurologic sequelae in patients who survive. We report a rare case of purely ligamentous atlanto-occipital and atlantoaxial dissociation in a polytrauma patient after being struck by a vehicle as a pedestrian. We describe the unique clinical, imaging, intraoperative findings, and outcomes associated with this injury. Remarkable findings included absent sensorimotor function in all extremities, no rectal tone, autonomic dysregulation, as well as absent bulbocavernosus, babinski and clonus reflexes. Despite the poor prognosis associated with this injury, posterior cervical fusion from the occiput to C4 was indicated for care purposes and mitigation of additional neurologic complications. Moreover, craniocervical stabilization remains the gold standard for treatment of cervical instability when indicated, regardless of an anticipated good or poor prognosis.