Atlantooccipital dislocation (C0/C1)

An atlantooccipital dislocation is a severe injury of the upper cervical spine with a dislocation of the joint portions between the occipital bone and the 1st cervical vertebra. It occurs only rarely.

The following dislocation types are distinguished according to the direction of dislocation of the condyle masses of the occipital bone in relation to the 1st cervical vertebra:

• Type I with dislocation toward the front (ventral)
• Type II with dislocation toward the back (dorsal)
• Type III with axial distraction of the atlantooccipital joints
• Type IV with dislocation to the side (lateral)

• Pronounced soft tissue swelling neck and head
• Cranial nerve VI–XII failure
• Symptoms of pinched brain stem, up to and including paralysis of respiratory and circulatory centers (gasping respiration, cardiac dysrhythmias)
• This injury is frequently fatal at the site of the accident.
• Patients who survive the injury often exhibit permanent neurological symptoms, up to and including tetraplegia (paraplegia in which arms and legs are affected).

Following primary survival of this severe injury, the following surgical options are open:

• Transoral C0/C1 fusion
• Dorsal C0/C1 fusion
• C0/C1/C2 fusion as needed.