Shatsky Joshua B, Alton Timothy B, Bellabarba Carlo, Bransford Richard J
Department of Orthopedics and Sports Medicine, Harborview Medical Center, 325 Ninth Avenue Seattle, WA 98104, USA.
Case Rep Orthop. 2016;2016:4930285. doi: 10.1155/2016/4930285. Epub 2016 Jun 5.
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).
研究设计。回顾性病例报告及综述。目的。颅颈脱位（CCD）通常是一种严重损伤。已发现诊断延迟会导致更差的预后。我们的目的是描述一例隐匿性颅颈脱位的罕见病例，并利用该病例突出关键的临床和影像学表现，以确保快速诊断和恰当处理，避免延误及随后的神经功能恶化。方法。病例报告及文献综述。结果。我们描述了一例独特的隐匿性颅颈脱位病例，最初的颈椎影像学检查未显示枕颈（O-C1）关节或C1-C2关节的移位。对细微影像学线索的仔细评估提示损伤比最初检查更为严重。由于这些细微线索而进行的进一步影像学检查证实了真正的颅颈脱位，随后进行了治疗，未遗留神经后遗症。结论。对CCD的高度怀疑指数可能会防止在未出现明显脊髓损伤的特定患者中发生损伤。仔细考虑相关骨折、软组织损伤及损伤机制是正确诊断和处理颅颈交界区（CCJ）损伤的关键线索。
