Atlanto-Occipital Rotatory Dislocation: A Case Report and Systematic Review

World Neurosurg. 2018 Feb;110:106-114. doi: 10.1016/j.wneu.2017.11.005. Epub 2017 Nov 10.


Background: Atlanto-occipital rotatory dislocation (AORD) has rarely been reported in the literature; for this reason, the clinicoradiologic characteristics of this injury are not well described.

Methods: We describe the case of a 67-year-old man who sustained a cervical spine trauma. He reported only neck pain and was neurologically intact. A computed tomography scan showed a rotatory displacement of the atlanto-occipital joints associated with a widened condylar-C1 interval; in addition, magnetic resonance imaging showed injuries to the stabilizing ligaments of this area. A systematic literature review was also performed to identify previous cases of patients with AORD.

Results: The patient was treated with craniocervical fixation from occipital to C1, achieving a good outcome. The literature review yielded 9 cases of patients with AORD. Compared with patients with atlanto-occipital dislocation, patients with rotatory dislocations have a less severe degree of displacement of the atlanto-occipital joints and better clinical outcome.

Conclusions: Compared with previously classified atlanto-occipital dislocations, AORD is an independent and unique variation. AORD presents with different biomechanical, clinicoradiologic, and prognostic characteristics and represents an important addition to the spectrum of atlanto-occipital dislocation injuries.

Keywords: Atlanto-occipital dislocation; Atlanto-occipital dissociation; Atlanto-occipital rotatory dislocation; Occipitoatlantal dislocation.

Publication types

  • Case Reports
  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Atlanto-Occipital Joint / diagnostic imaging
  • Atlanto-Occipital Joint / surgery*
  • Cervical Vertebrae / diagnostic imaging
  • Databases, Bibliographic / statistics & numerical data
  • Humans
  • Joint Dislocations / diagnostic imaging
  • Joint Dislocations / pathology*
  • Joint Dislocations / surgery*
  • Magnetic Resonance Imaging
  • Male
  • Surgical Fixation Devices
  • Tomography, X-Ray Computed