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Seminars in Neurosurgery 2002; 13(2): 151-158
DOI: 10.1055/s-2002-35812
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Occipital Condyle Trauma

Stephan J. du Plessis
  • University of Calgary Spine Program, Division of Neurosurgery, Department of Clinical Neurosciences, Calgary, Alberta, Canada
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Publication History

Publication Date:
28 November 2002 (online)

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ABSTRACT

Traumatic lesions involving the occipital condyles and their ligamentous structures are infrequently seen in neurosurgical practice. The clinical spectrum of these injuries is vast and varies from the highly unstable occipitocervical dislocation to relatively insignificant and uncomplicated occipital condyle fractures.

These injuries can be very difficult to diagnose on plain films. A high index of suspicion and a low threshold for further definitive imaging is warranted. Significant closed head injuries, lower cranial nerve deficits, brainstem dysfunction, and other cervical spine fractures have been associated with C0 trauma. Thin-section computed tomography (CT) with coronal and sagittal reformatting of the craniocervical junction should be considered as the minimum standard of care in these patients. In patients in which occipital injury is clinically suspected and CT is inconclusive, magnetic resonance imaging (MRI) is indicated. Occipital condyle fractures can generally be treated by external immobilization, whereas occipitocervical dislocations mandate immediate rigid external immobilization followed by early occipitocervical fixation and fusion.

KEYWORDS

Occipitocervical dislocation - occipital condyle fracture - occipitocervical fusion

REFERENCES

  • 1 Ahuja A. Radiology in survivors of traumatic atlanto-occipital dislocation.  Surg Neurol . 1994;  41 112-118
    PubMedGoogle Scholar
  • 2 Chattar-Cora D, Valenziano C P. Atlanto-occipital dislocation: a report of three patients and a review.  J Orthop Trauma . 2000;  14 370-375
    CrossrefPubMedGoogle Scholar
  • 3 Ferrera P C, Bartfield J M. Traumatic atlanto-occipital dislocation: a potentially survivable injury.  Am J Emerg Med . 1996;  14 291-296
    CrossrefPubMedGoogle Scholar
  • 4 Smith D C. Atlanto-occipital dislocation.  J Emerg Med . 1992;  10 699-703
    CrossrefPubMedGoogle Scholar
  • 5 Adams V I. Neck injuries: I. Occipitoatlantal dislocation-a pathologic study of twelve traffic fatalities.  J Forensic Sci . 1992;  37 556-564
    PubMedGoogle Scholar
  • 6 Alker Jr J G, Oh Y S, Leslie E V. High cervical spine and craniocervical junction injuries in fatal traffic accidents: a radiological study.  Orthop Clin North Am . 1978;  9 1003-1010
    PubMedGoogle Scholar
  • 7 Tepper S L, Fligner C L, Reay D T. Atlanto-occipital disarticulation. Accident characteristics.  Am J Forensic Med Pathol . 1990;  11 193-197
    PubMedGoogle Scholar
  • 8 Bucholz R W, Burkhead W Z. The pathological anatomy of fatal atlanto-occipital dislocations.  J Bone Joint Surg Am . 1979;  61 248-250
    PubMedGoogle Scholar
  • 9 Bulas D I, Fitz C R, Johnson D L. Traumatic atlanto-occipital dislocation in children.  Radiology . 1993;  188 155-158
    CrossrefPubMedGoogle Scholar
  • 10 Cohen A. Traumatic atlanto-occipital dislocation in children: review and report of five cases.  Pediatr Emerg Care . 1991;  7 24-27
    PubMedGoogle Scholar
  • 11 Houle P, McDonnell D E, Vender J. Traumatic atlanto-occipital dislocation in children.  Pediatr Neurosurg . 2001;  34 193-197
    CrossrefPubMedGoogle Scholar
  • 12 Kaufman R A. Traumatic longitudinal atlanto-occipital distraction injuries in children.  Am J Neuroradiol . 1982;  3 415-419
    PubMedGoogle Scholar
  • 13 Kaufman R A, Carroll C D, Buncher C R. Atlantooccipital junction: standards for measurement in normal children.  Am J Neuroradiol . 1987;  8 995-999
    PubMedGoogle Scholar
  • 14 Traynelis V C. Traumatic atlanto-occipital dislocation. Case report.  J Neurosurg . 1986;  65 863-870
    CrossrefPubMedGoogle Scholar
  • 15 Anderson P A, Montesano P X. Morphology and treatment of occipital condyle fractures.  Spine . 1988;  13 731-736
    CrossrefPubMedGoogle Scholar
  • 16 Tuli S. Occipital condyle fractures.  Neurosurgery . 1997;  41 368-377
    CrossrefPubMedGoogle Scholar
  • 17 de Oliveira E, Rhoton Jr L A, Peace D. Microsurgical anatomy of the region of the foramen magnum.  Surg Neurol . 1985;  24 293-352
    CrossrefPubMedGoogle Scholar
  • 18 Katsuta T. Trajectory of the hypoglossal nerve in the hypoglossal canal: significance for the transcondylar approach.  Neurol Med Chir (Tokyo) . 2000;  40 206-210
    PubMedGoogle Scholar
  • 19 Rhoton Jr L A. The foramen magnum.  Neurosurgery . 2000;  47(3 suppl) S155-S193
    PubMedGoogle Scholar
  • 20 Wen H T. Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach.  J Neurosurg . 1997;  87 555-585
    CrossrefPubMedGoogle Scholar
  • 21 Bridgman S A, McNab W. Traumatic occipital condyle fracture, multiple cranial nerve palsies, and torticollis: a case report and review of the literature.  Surg Neurol . 1992;  38 152-156
    PubMedGoogle Scholar
  • 22 Cirak B, Akpinar G, Palaoglu S. Traumatic occipital condyle fractures.  Neurosurg Rev . 2000;  23 161-164
    PubMedGoogle Scholar
  • 23 Clayman D A, Sykes C H, Vines F S. Occipital condyle fractures: clinical presentation and radiologic detection.  Am J Neuroradiol . 1994;  15 1309-1315
    PubMedGoogle Scholar
  • 24 Devi B I. Fracture occipital condyle with isolated 12th nerve paresis.  Neurol India . 2000;  48 93-94
    PubMedGoogle Scholar
  • 25 Fuentes S. Occipital condyle fractures and clivus epidural hematoma. Case report.  Neurochirurgie . 2000;  46 563-567
    PubMedGoogle Scholar
  • 26 Goldstein S J, Woodring J H, Young A B. Occipital condyle fracture associated with cervical spine injury.  Surg Neurol . 1982;  17 350-352
    PubMedGoogle Scholar
  • 27 Kelly A, Parrish R. Fracture of the occipital condyle: the forgotten part of the neck.  J Accid Emerg Med . 2000;  17 220-221
    PubMedGoogle Scholar
  • 28 Legros B. Basal fracture of the skull and lower (IX, X, XI, XII) cranial nerves palsy: four case reports including two fractures of the occipital condyle-a literature review.  J Trauma . 2000;  48 342-348
    PubMedGoogle Scholar
  • 29 Orbay T. Late hypoglossal nerve palsy following fracture of the occipital condyle.  Surg Neurol . 1989;  31 402-404
    CrossrefPubMedGoogle Scholar
  • 30 Schliack H, Schaefer P. Hypoglossal and accessory nerve paralysis in a fracture of the occipital condyle.  Nervenarzt . 1965;  36 362-364
    PubMedGoogle Scholar
  • 31 Su T M. Occipital condyle fracture with hypoglossal nerve palsy: case report.  J Trauma . 2000;  49 1144-1146
    PubMedGoogle Scholar
  • 32 Wani M A. Collet-Sicard syndrome resulting from closed head injury: case report.  J Trauma . 1991;  31 1437-1439
    PubMedGoogle Scholar
  • 33 Bettini N. Fractures of the occipital condyles: report of four cases and review of the literature.  Skeletal Radiol . 1993;  22 187-190
    PubMedGoogle Scholar
  • 34 Bloom A I. Occipital condyle fracture and ligament injury: imaging by CT.  Pediatr Radiol . 1996;  26 786-790
    CrossrefPubMedGoogle Scholar
  • 35 Bloom A I. Fracture of the occipital condyles and associated craniocervical ligament injury: incidence, CT imaging and implications.  Clin Radiol . 1997;  52 198-202
    CrossrefPubMedGoogle Scholar
  • 36 Bundschuh C V. Magnetic resonance imaging of suspected atlanto-occipital dislocation. Two case reports.  Spine . 1992;  17 245-248
    PubMedGoogle Scholar
  • 37 Chaljub G. Traumatic atlanto-occipital dislocation: MRI and CT.  Neuroradiology . 2001;  43 41-44
    CrossrefPubMedGoogle Scholar
  • 38 Deliganis A V. Radiologic spectrum of craniocervical distraction injuries.  Radiographics . 2000;  20 S237-S250
    PubMedGoogle Scholar
  • 39 Mariani P J. Occipital condyle fracture presenting as retropharyngeal hematoma.  Ann Emerg Med . 1990;  19 1447-1449
    PubMedGoogle Scholar
  • 40 Noble E R, Smoker W R. The forgotten condyle: the appearance, morphology, and classification of occipital condyle fractures.  Am J Neuroradiol . 1996;  17 507-513
    PubMedGoogle Scholar
  • 41 Spencer J A, Yeakley J W, Kaufman H H. Fracture of the occipital condyle.  Neurosurgery . 1984;  15 101-103
    PubMedGoogle Scholar
  • 42 Harris Jr H J. Radiologic diagnosis of traumatic occipitovertebral dissociation: 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects.  Am J Roentgenol . 1994;  162 887-892
    PubMedGoogle Scholar
  • 43 Dickman C A. Traumatic occipitoatlantal dislocations.  J Spinal Disord . 1993;  6 300-313
    CrossrefPubMedGoogle Scholar
  • 44 Wertheim S B, Bohlman H H. Occipitocervical fusion. Indications, technique, and long-term results in thirteen patients.  J Bone Joint Surg Am . 1987;  69 833-836
    PubMedGoogle Scholar
  • 45 Young W F. Diagnosis and management of occipital condyle fractures.  Neurosurgery . 1994;  34 257-261
    PubMedGoogle Scholar
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