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Atlanto-occipital dislocation

Definition
AOD is the loss of stability between the atlas and axis (C1-C2) that results in loss of normal articulation of the upper cervical spine to the occiput.
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Pathophysiology
AOD is caused due to trauma (head injuries, type II fractures), congenital conditions (Down's syndrome, skeletal dysplasias, Goldenhar syndrome, spondyloepiphyseal dysplasia, Morquio syndrome, occipitalization of atlas), and inflammation (chronic rheumatoid arthritis).
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Disease course
The injury of ligaments between the occiput and upper cervical spine results in AOD, which causes clinical manifestations of severe neck pain, lower cranial nerve deficits, unilateral/bilateral weakness, and quadriplegia, unconsciousness, respiratory arrest, spinal nerve injury, neurogenic shock, and cerebrovascular injury.
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Prognosis and risk of recurrence
AOD is associated with a mortality of 26%.
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Key sources
The following summarized guidelines for the evaluation and management of atlanto-occipital dislocation are prepared by our editorial team based on guidelines from the American Association of Neurological Surgeons (AANS/CNS 2013).
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Guidelines

1.Diagnostic investigations

Lateral cervical radiographs: obtain a lateral cervical X-ray for the diagnosis of AOD.
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2.Therapeutic procedures

Traction: avoid traction in the management of patients with AOD, as it is associated with a 10% risk of neurological deterioration.
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3.Surgical interventions

Internal fixation: perform internal fixation and fusion for definitive management of AOD.
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