Abstract
Study Design. Retrospective case report and review. Objective. Cranial cervical dislocation (CCD) is commonly a devastating injury. Delay in diagnosis has been found to lead to worse outcomes. Our purpose is to describe a rare case of occult cranial cervical dislocation (CCD) and use it to highlight key clinical and radiographic findings to ensure expedited diagnosis and proper management avoiding delays and subsequent neurologic deterioration. Method. Case report with literature review. Results. We describe a unique case of occult cranial cervical dislocation where initial imaging of the cervical spine failed to illustrate displacement of the occipital-cervical (O-C1) articulation or C1-C2 articulation. Careful evaluation of subtle radiographic clues suggested a more severe injury than initial review. Additional imaging was obtained due to these subtle clues confirming true cranial cervical dislocation allowing subsequent treatment with no neurologic sequelae. Conclusion. A high index of suspicion of CCD may prevent injury in select patients who present without gross cord compromise. Careful consideration of associated fractures, soft tissue injuries, and mechanism of injury are essential clues to the correct diagnosis and management of injuries to the craniocervical junction (CCJ).
Highlights
Injury to the craniocervical junction can be devastating
From ventral to dorsal these are the alar ligament, cruciate ligament, and tectorial membrane
We present a case of occult cranial cervical dislocation, which could have been missed without careful consideration of associated fractures, soft tissue clues, and mechanism
Summary
Injury to the craniocervical junction can be devastating. Delays in diagnosis or failure to appreciate this injury lead to neurologic deterioration and poor outcomes. We present a case of occult cranial cervical dislocation, which could have been missed without careful consideration of associated fractures, soft tissue clues, and mechanism Because this injury was recognized, devastating neurological and life-threatening consequences were avoided. He was noted to have severe facial trauma and complex neck lacerations (Figure 1) Given his mechanism of injury and significant soft tissue trauma and deteriorating clinical picture, a whole body computed tomography (CT) scan was performed. The tricortical graft was contoured around the posterior elements between the occiput and C2 and secured with #2 FiberWire wrapped around both rods (Figure 9) After closure, his care was turned over to the Otolaryngology Service for neck exploration and complex wound closure. He was discharged home ten days after presentation with no neurologic sequelae
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