Occipitocervical Dissociation

synonyms:

Occipitocervical Dissociation ICD-9

Occipitocervical Dissociation Etiology / Epidemiology / Natural History

• High energy trauma
• Often fatal

Occipitocervical Dissociation Anatomy

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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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