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Atlanto-occipital dislocation, orthopedic decapitation, or internal decapitation describes ligamentous separation of the spinal column from the skull base. It is possible for a human to survive such an injury; however, 70% of cases result in immediate death .
The atlanto-occipital joint may be dislocated, especially from violent accidents such as traffic collisions. [1] This may be diagnosed using CT scans or magnetic resonance imaging of the head and neck. [1] Surgery may be used to fix the joint and any associated bone fractures. [1] Neck movement may be reduced long after this injury. [1]
Craniocervical instability (CCI) is a medical condition characterized by excessive movement of the vertebra at the atlanto-occipital joint and the atlanto-axial joint located between the skull and the top two vertebra, known as C1 and C2.
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The clivus is an important landmark for checking for anatomical atlanto-occipital alignment. When viewed on a lateral C-spine radiograph, the clivus forms a line which, if extended, is known as Wackenheim's clivus line. Wackenheim's clivus line should pass through the dens of the axis or be tangential to it. [9]
The craniocervical junction usually stays stable, but neurologic injury may occur from the blow to the head. Type III: Isolated avulsion of the condyle with displacement towards the alar ligament, due to forced rotation / lateral bending. This injury tends to be unstable and may co-occur with atlanto-occipital subluxation or dislocation.
A widening of the atlanto-axial joint, as measured between the posterior surface of the anterior arch of atlas and the front of the odontoid process, indicates an injury to the transverse atlantal ligament. [6] Normally, this atlanto-dental distance is less than 2 mm, sometimes a maximum of 3 mm is accepted in men and 2.5 mm in women. [6]
Atlantoaxial instability is a common asymptomatic finding in rheumatoid arthritis patients. [3] However, it can lead to cervical myelopathy. [4] Patients with atlantoaxial instability can experience neck pain and headaches in the back of the head (occipital headaches).