Occipitocervical Dissociation
synonyms:
Occipitocervical Dissociation ICD-9
Occipitocervical Dissociation Etiology / Epidemiology / Natural History
- High energy trauma
- Often fatal
Occipitocervical Dissociation Anatomy
Occipitocervical Dissociation Clinical Evaluation
- Palpate entire spine for tenderness / step off.
- Complete neuro exam: motor strength, pin-prick sensation, reflexes, cranial nerves, rectal examination (perineal pin-prick sensation, sphincter tone, volitional spincter control)
- Absence of the bulbocaverosus reflex indicates spinal shock. Level of spinal injury can not be determined until bulbocaverosus reflex has returned.
- See ASIA form.
Occipitocervical Dissociation Xray / Diagnositc Tests
- A/P, Lateral, Odontoid: findings may be suttle, evaluate relationship of occipute to the Atlas, small avulsion fractures, soft-tissue swelling
- CT cervical spine:
- MRI: i
Occipitocervical Dissociation Classification / Treatment
- Immediate reduction with halo vest placement indicated followed by insturmented arthrodesis. (Vaccaro AR, Injury 2005;35(suppl 2):B44).
Occipitocervical Dissociation Associated Injuries / Differential Diagnosis
- C-Spine Trauma Differential Diagnosis
- Brainstem injury
- Vertebrobasilar arterial injury
- Subarachnoid hemorrhage
- Posterior pharyngeal wall disruption
- Head injury
- Skull base fracutres
- Lower cranial nerve palsies (CN12)
- Upper cervical spine injuries
Occipitocervical Dissociation Complications
Occipitocervical Dissociation Follow-up Care
Occipitocervical Dissociation Review References
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