Atlanto-occipital dislocation (AOD) is the most common cervical spine injury in motor vehicular accident fatalities. It carries a high morbidity and mortality. Diagnosis of this injury is difficult and requires a high index of clinical suspicion combined with careful examination of imaging modalities. A 22-year-old female was in a motor vehicle accident and was found unresponsive. She sustained multiple injuries requiring emergency laparotomy and damage control laparotomy. CT of Cervical spine was initially read as negative. Ten days later, the patient had no movement of her lower extremities. It was discovered that craniocervical dissociation was missed on the CT done on admission; CT angiogram done to rule out blunt carotid and vertebral artery injury showed realignment of the spine. The patient underwent surgery and recovered the use of her legs. Spontaneous realignment pre-operatively for AOD has not been reported in the literature because most cases underwent immediate surgery for stabilization.
Wilson J, Ginsberg J, Paullus CP and Santos PA