Traumatic occipitocervical instability

Traumatic occipitocervical instability (OCI) is a serious injury which often leads to death. It represents a group of instabilities at the occipitoatlantoaxial (C⁰-C₁-C₂) region. With the improvement in emergency transport services, more patients survive the injury. Over a 24-month period beginning July 1993, 4 patients of 82 cervical spinal injuries had traumatic OCI with an incidence of 5%. Three of these OCI patients were injured in deceleration crashes of their motorcycle (distractive or distractive flexion injury), and displayed either anterior displacement or vertical distraction of C₀-C₁ on C₂. The remaining patient was a hanging suicide (distractive rotatory-extension injury), and showed posterior C₀-C₁ dislocation. At admission, all four OCI patients presented in a state of unconsciousness, complete quadriplegia and ventilator dependence. Three of the four patients died of primary brain stem injury within 48 hours of admission. The remaining patient who regained consciousness following emergency resuscitation and Gardner-Wells skeletal traction survived for over two weeks with unchanged quadriplegia and ventilator dependence. Clinical presentations, trauma mechanisms, radiological findings as well as outcome of the 4 patients are discussed.