Atlanto-occipital Dissociation: A Review on Epidemiology, Recognition and Diagnosis, Management Options, Outcomes, and Future Directions.

IF 1.6 4区 医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2024-11-01 Epub Date: 2024-09-30 DOI:10.1097/BSD.0000000000001701
William L Sheppard, Jason W Savage, Tim Moore
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Abstract

Atlanto-occipital dissociation (AOD) is an extremely common injury but often fatal. In a systematic review from 2010, AODs were present in almost 20% of blunt trauma fatalities. It is an injury many patients do not survive; therefore, few are treated, even at high volume trauma centers. In survivors, his injury is often missed or the diagnosis is often delayed. Mortality rates commonly reach beyond 60% when injury patterns go unrecognized. Approximately 50% of patients with AOD sustain blunt cerebrovascular injury and nearly 20% of patients present with traumatic brain injury (TBI) or stroke. This pathology was once considered uniformly fatal. However, over the last 20 years, significant advancements have been made both clinically and radiographically, to better identify and manage this injury pattern. Despite improvements in clinical comprehension and improved time to diagnosis, less than 75% of cases are currently recognized within 24 hours. Less than 40% of patients who suffer AOD are independent with functionality, without neurological impairment. This article reviews current literature regarding AOD in hopes to improve timing to diagnosis, subsequent prognosis, timing to fixation or stabilization, and postoperative recovery.

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寰枕分离:关于流行病学、识别和诊断、管理方案、结果和未来方向的综述。
寰枕分离(AOD)是一种极为常见的损伤,但往往是致命的。在 2010 年的一项系统回顾中,近 20% 的钝性创伤死亡病例中都存在寰枕分离。许多患者在这种损伤中无法存活,因此,即使在高流量的创伤中心,也很少有人接受治疗。在幸存者中,其损伤往往被漏诊或延误诊断。如果损伤模式未被识别,死亡率通常会超过 60%。大约 50% 的 AOD 患者会受到钝性脑血管损伤,近 20% 的患者会出现创伤性脑损伤 (TBI) 或中风。这种病理现象曾被认为是致命的。然而,在过去的 20 年里,临床和影像学方面都取得了重大进展,可以更好地识别和处理这种损伤模式。尽管临床理解能力有所提高,诊断时间也有所缩短,但目前只有不到 75% 的病例能在 24 小时内得到确认。只有不到 40% 的 AOD 患者可以独立活动,没有神经系统损伤。本文回顾了目前有关 AOD 的文献,希望能改进诊断时机、后续预后、固定或稳定时机以及术后恢复。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Spine Surgery
Clinical Spine Surgery Medicine-Surgery
CiteScore
3.00
自引率
5.30%
发文量
236
期刊介绍: Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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