Traumatic atlanto-occipital dislocation in children

Traumatic atlanto-occipital dislocation is seen in approximately 25% of fatal pediatric trauma. This was previously considered to be a rare and fatal entity, however with improvements in resuscitation in the field, many patients who previously might have died are now evaluated in the hospital. Treatment of atlanto-occipital instability is internal fixation. Many authors have advocated supplemental external immobilization with a halo vest. However, there are several circumstances where the application of a halo vest is undesirable. Thus a method of internal fixation and fusion that is rigid enough not to require supplemental external orthosis is necessary. We present 2 cases of atlanto-occipital dislocation which were treated with Locksley intersegmental tie bar occipital cervical fusion. Both patients achieved solid fusion without supplemental halo bracing, and made complete neurologic recoveries. Traumatic atlanto-occipital dislocation is a potentially survivable injury that requires aggressive resuscitation in the field, a high index of suspicion and early definitive surgical stabilization.