Epidemiology, management, and outcomes of traumatic atlantooccipital dislocation: National registry study
Year: 2025
Type: article
Study design: Observational Study
Abstract: Study design: National registry–based observational cohort study. Objective: This study describes the epidemiology, surgical management, and outcomes of traumatic atlantooccipital dislocation (AOD). Summary of background data: Traumatic AOD is a rare and devastating injury. High volume trauma centers report 1–3 cases annually, and most prior publications are case series. Methods: The National Trauma Data Bank (2017–2022) identified patients with AOD (ICD-10 diagnosis code S13.11). Surgical stabilization was examined as occipital cervical fusion or internal fixation. Mortality was examined as death before admission, death after admission, and survival to discharge. Analyses included χ2 tests and multivariate logistic regression. Results are presented as adjusted odds ratios and 95% CI. Results: Traumatic AOD was diagnosed in 0.08% (n=4,631) of 5,775,304 trauma patients. Twenty-one percent of admitted patients were surgically stabilized. Odds of surgery decreased for hemodynamic instability in the ED (0.6 [0.5–0.7]) and age ≥70 (0.5 [0.3–0.7]), while there were greater odds of surgery for injuries from motor vehicle crash (2.6 [1.8–3.6]) or auto-pedestrian strike (1.6 [1.1–2.4]) versus falls, and the presence of upper cervical and head injuries: cervical ligament sprain (2.5 [2.1–3.0]), partial SCI (1.7 [1.3–2.1]), TBI (1.4 [1.1–1.7]), atlas fracture (1.4 [1.1–1.7]), and other cervical ligament dislocation (1.4 [1.1–1.8]). Overall mortality was 51%. Of those, 51% died after admission. For admitted patients, survival was 95% with surgery and 58% without surgery. There were greater odds of mortality for ED GCS ≤8 (26.2 [19.6–34.9]), age ≥70 (5.2 [3.4–8.1]), and 50–69 years (2.0 [1.4–2.9]) vs. <18 years, complete SCI (3.6 [2.1–6.3]), and hemodynamic instability (2.5 [2.0–3.1]), while odds of mortality decreased for surgical stabilization (0.04 [0.03–0.06]), cervical ligamentous injury (0.4 [0.3–0.5]), and injuries from falls versus all other causes. In surgically managed patients, mortality odds were higher with ED GCS ≤8 (7.4 [2.9–18.8]) and age ≥70 (6.1 [1.6–24.2]) versus age <18. Conclusions: These findings from a large National registry suggest that traumatic AOD is both treatable and survivable in select patients. Surgical stabilization is associated with survival, particularly for nongeriatric patients presenting without severe neurological deficits. Level of evidence: Level III.
Source: Spine Open
Authors: David Acuna, Kristin Salottolo, Alejandro Betancourt, Carlos H. Palacio, Robert Madayag, Peter Syre, Kaysie Banton, David Bar-Or
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4413699167