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Improved prehospital care and diagnostics have enhanced survivability, underscoring the need for prompt stabilization without traction to avert secondary spinal cord injury (SCI). This combined clinical-forensic study evaluates modern management, survival, and neurological outcomes in AOD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Retrospective multicenter review (6 German level I trauma centers, 2007\u20132023) of 19 AOD cases, plus forensic analysis of 897 road traffic accident (RTA) autopsies (2003\u20132023) for AOD frequency and mechanisms. Outcomes included mortality, AIS grades (ISNCSCI 2019\/2023), and clinical neurological status. Statistics: Welch t-test, chi-square; exploratory (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200919\/92 total, no power).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean age 41 years (range 9\u201386). Traynelis types I:3, II:14, III:2. Mean GCS arrival: 6 (3\u201315). Two patients (10.5%) died preoperatively. Of 17 surgical patients, 5 (29.4%, 95% CI 13.0\u201352.6%) died postoperatively, yielding overall in-hospital mortality 7\/19 (36.8%, 95% CI 19.1\u201359.0%). Of 12 survivors, 2\/12 (16.7%, 95% CI 4.7\u201344.8%) improved\u2009\u2265\u20091 AIS grade; 10\/12 (83.3%, 95% CI 55.2\u201395.3%) showed clinical neurological improvement per clinicians (e.g., motor gains\/vent wean in stable AIS D; AIS insensitive for incompletes\u2014Kirshblum, Spinal Cord 2022). Forensic: AOD in 8.1% RTA fatalities (73\/897; 57 no SCI\u2009+\u200916 SCI), brainstem lacerations (65%), aortic injuries (48%) dominant; polytrauma (52%) leading death cause (chi-sq vs. non-AOD\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012). Dens\u2013McGregor distance higher in deaths (10.8\u00a0mm SD 5.7 vs. survival 5.8\u00a0mm SD 4.1; Welch\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.068, power\u2009=\u20090.12).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AOD survivorship\u2009~\u200963%, with dual metrics revealing 83% clinical improvement post-stabilization (17% AIS shifts). Forensic data (chi-sq link) frame prehospital risks (e.g., traction aligning with brainstem patterns), suggesting time-critical occipitocervical fusion (C0\u2013C2) without traction. Early high-resolution CT pivotal.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00586-026-09821-4","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T09:31:30Z","timestamp":1772098290000},"page":"2604-2614","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Survival and neurological outcomes after traumatic atlanto-occipital dislocation: a combined multicenter clinical and forensic study"],"prefix":"10.1007","volume":"35","author":[{"given":"Johannes","family":"Ebken","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarabi","family":"Alireza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Nils","family":"K\u00fcchler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Weisser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Gembruch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Pollok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Blume","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Schick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicki M.","family":"Butenschoen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Lange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"issue":"3","key":"9821_CR1","first-page":"335","volume":"97","author":"M Ehlinger","year":"2011","unstructured":"Ehlinger M, Charles YP, Adam P, Bierry G, Dosch JC, Steib JP et al (2011) Survivor of a traumatic atlanto-occipital dislocation. 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