Abstract
Objective. To review the literature on atlanto-occipital dislocation (AOD) in adults to determine the optimal classification, diagnostic method and treatment.Material and Methods. A search was conducted in the PubMed database for the period from 1966 to 2020. The initial search revealed 564 abstracts of articles. A total of 95 studies were selected for a detailed study of the full text, of which 47 studies describing data from 130 patients were included in this review.Results. The paper describes all the available AOD classifications, and discusses their advantages and disadvantages. The clinical picture, features of the diagnosis in published observations of AOD in adults, as well as the applied treatment methods and their results are presented.Conclusion. Atlanto-occipital dislocation is one of the most severe types of injuries of the cervical spine in adults, which is accompanied by damage to the medulla oblongata and gross neurological deficit in 70 % of cases. The sensitivity of radiography for the diagnosis of AOD was 56.3 %. In 18.5 % of patients, its use led to untimely diagnosis and could cause subsequent deterioration. The CT sensitivity was 96.8 %. The most accurate method of AOD verification was to determine the atlanto-occipital interval (100 % sensitivity and specificity). The optimal method of treating victims with AOD is surgical one.
Highlights
A search was conducted in the PubMed database for the period
A total of 95 studies were selected for a detailed study of the full text
of which 47 studies describing data from 130 patients were included in this review
Summary
Анализ литературы по теме атлантоокципитальной дислокации у взрослых для определения оптимальной классификации, метода диагностики и лечения. Представлены клиническая картина, особенности диагностики в опубликованных наблюдениях атлантоокципитальных дислокаций у взрослых, а также примененные методы лечения и их результаты. Атлантоокципитальная дислокация является одним из наиболее тяжелых видов повреждений шейного отдела позвоночника у взрослых, которая в 70 % случаев сопровождается повреждением продолговатого мозга и грубым неврологическим дефицитом. Чувствительность рентгенографии для диагностики атлантоокципитальных дислокаций составила 56,3 %, у 18,5 % ее применение привело к несвоевременной диагностике и могло послужить причиной последующего ухудшения. Наиболее точным методом верификации атлантоокципитальных дислокаций является определение атлантоокципитального интервала (100 % чувствительность и специфичность). Для цитирования: Гринь А.А., Львов И.С., Кордонский А.Ю., Коновалов Н.А., Крылов В.В. Современные концепции классификации, диагностики и лечения атлантоокципитальных дислокаций у взрослых: несистематический обзор литературы // Хирургия позвоночника.
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