{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T13:04:21Z","timestamp":1783602261889,"version":"3.55.0"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T00:00:00Z","timestamp":1674518400000},"content-version":"vor","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg Rep"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Study Design\u2003Case series with surgical technical note.<\/jats:p><jats:p>\n          Objectives\u2003This article reports experiences and results of muscle-preserving temporary C0-C2 fixation for the treatment of atlanto-occipital dislocation (AOD).<\/jats:p><jats:p>\n          Methods\u2003AOD is a rare injury caused by high-energy trauma, occurring in less than 1% of pediatric trauma patients. Recommended treatment is C0-C2 fusion which, however, will result in significant loss of mobility in the craniocervical junction (CCJ), especially C1-C2 rotation. An alternative approach, with the ability of preserving mobility in the C1-C2 segment, is a temporary fixation that allows the ligaments to heal, after which the implants can be removed to regain function in the CCJ joints. By using a muscle-preserving approach and navigation for the C2 screws, a relatively atraumatic fixation of the CCJ can be achieved with motion recovery after implant removal.<\/jats:p><jats:p>\n          Results\u2003We present two cases of AOD treated with temporary fixation. A 12-year-old boy involved in a frontal car collision, as a strapped back seat passenger, was treated with temporary C0-C2 fixation for 10 months. Follow-up at 11 months after implant removal included clinical evaluation, computed tomography, magnetic resonance imaging (MRI), and flexion-extension X-rays. He was free of symptoms at follow-up. The CCJ was radiographically stable and he had 45\u2009degrees of C1-C2 rotation.<\/jats:p><jats:p>A 7-year-old girl was hit by a car as she got off a bus. She was treated with temporary fixation for 4 months after which the implant was removed. Follow-up at 8 years included clinical evaluation and MRI in rotation. She was free of symptoms. The ligaments of the CCJ appeared normal and her C1-C2 rotation was 30\u2009degrees.<\/jats:p><jats:p>\n          Conclusion\u2003C0-C2 fixation without fusion allows the CCJ ligaments to heal in pediatric AOD. By removing the implants after ligament healing, rotation in the C1-C2 segment can be regained without subsequent instability. Both our patients tolerated the treatment well and were free of symptoms at follow-up.<\/jats:p><jats:p>By using minimally invasive muscle-preserving technique and navigation, temporary fixation of the CCJ can be achieved with minimal damage to the soft tissues allowing recovery of almost normal function after implant removal.<\/jats:p>","DOI":"10.1055\/s-0043-1760830","type":"journal-article","created":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T00:02:56Z","timestamp":1674604976000},"page":"e11-e16","source":"Crossref","is-referenced-by-count":3,"title":["A Novel Treatment of Pediatric Atlanto-Occipital Dislocation with Nonfusion Using Muscle-Preserving Temporary Internal Fixation of C0-C2: Case Series and Technical Note"],"prefix":"10.1055","volume":"84","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3905-7210","authenticated-orcid":false,"given":"Marek","family":"Holy","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, \u00d6rebro University Hospital, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilla","family":"Szigethy","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, \u00d6rebro University Hospital, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Joelson","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, \u00d6rebro University Hospital, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claes","family":"Olerud","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Uppsala University Hospital, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,1,24]]},"reference":[{"issue":"05","key":"ref1","first-page":"654","article-title":"III. Atlo-occipital dislocation: a case of fracture of the atlas and axis, and forward dislocation of the occiput on the spinal column, life being maintained for thirty-four hours and forty minutes by artificial respiration, during which a laminectomy was performed upon the third cervical vertebra","volume":"47","author":"N J Blackwood","year":"1908","journal-title":"Ann Surg"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1159\/000496832","article-title":"Traumatic occipitocervical distraction injuries in children: a systematic review","volume":"54","author":"A T Hale","year":"2019","journal-title":"Pediatr Neurosurg"},{"issue":"11","key":"ref3","doi-asserted-by":"crossref","first-page":"2385","DOI":"10.1016\/j.spinee.2015.07.003","article-title":"Traumatic atlantooccipital dislocation: comprehensive assessment of mortality, neurologic improvement, and patient-reported outcomes at a Level 1 trauma center over 15 years","volume":"15","author":"S K Mendenhall","year":"2015","journal-title":"Spine J"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"535","DOI":"10.3171\/2015.6.SPINE15226","article-title":"Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle-C1 interval","volume":"24","author":"E Martinez-Del-Campo","year":"2016","journal-title":"J Neurosurg Spine"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1227\/01.neu.0000303196.87672.78","article-title":"Atlanto-occipital dislocation\u2013part 2: the clinical use of (occipital) condyle-C1 interval, comparison with other diagnostic methods, and the manifestation, management, and outcome of atlanto-occipital dislocation in children","volume":"61","author":"D Pang","year":"2007","journal-title":"Neurosurgery"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1227\/01.NEU.0000290897.77448.1F","article-title":"Atlanto-occipital dislocation: part 1\u2013normal occipital condyle-C1 interval in 89 children","volume":"61","author":"D Pang","year":"2007","journal-title":"Neurosurgery"},{"issue":"01","key":"ref7","first-page":"19","article-title":"Evaluation of traumatic atlantooccipital dislocations","volume":"8","author":"C Lee","year":"1987","journal-title":"AJNR Am J Neuroradiol"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"881","DOI":"10.2214\/ajr.162.4.8141012","article-title":"Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects","volume":"162","author":"J H Harris Jr","year":"1994","journal-title":"AJR Am J Roentgenol"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"887","DOI":"10.2214\/ajr.162.4.8141013","article-title":"Radiologic diagnosis of traumatic occipitovertebral dissociation: 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects","volume":"162","author":"J H Harris Jr","year":"1994","journal-title":"AJR Am J Roentgenol"},{"issue":"06","key":"ref10","doi-asserted-by":"crossref","first-page":"429","DOI":"10.3171\/spi.2006.4.6.429","article-title":"Diagnosis and treatment of craniocervical dislocation in a series of 17 consecutive survivors during an 8-year period","volume":"4","author":"C Bellabarba","year":"2006","journal-title":"J Neurosurg Spine"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"113","DOI":"10.3171\/spi.2007.6.2.113","article-title":"Survivors of occipitoatlantal dislocation injuries: imaging and clinical correlates","volume":"6","author":"E M Horn","year":"2007","journal-title":"J Neurosurg Spine"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1055\/s-0031-1298597","article-title":"Pediatric atlanto-occipital dissociation: radiographic findings and clinical outcome","volume":"3","author":"J P du Plessis","year":"2012","journal-title":"Evid Based Spine Care J"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1227\/NEU.0b013e31827765e0","article-title":"The diagnosis and management of traumatic atlanto-occipital dislocation injuries","volume":"72","author":"N Theodore","year":"2013","journal-title":"Neurosurgery"},{"issue":"08","key":"ref14","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1007\/s00381-016-3118-y","article-title":"Traumatic atlanto-occipital dislocation: do children and adolescents have better or worse outcomes than adults? A narrative review","volume":"32","author":"R S Tubbs","year":"2016","journal-title":"Childs Nerv Syst"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1007\/s12178-016-9347-6","article-title":"Occipitocervical dissociation-incidence, evaluation, and treatment","volume":"9","author":"M K Kasliwal","year":"2016","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.nec.2007.09.004","article-title":"Cervical spine trauma in the pediatric patient","volume":"18","author":"P Klimo Jr.","year":"2007","journal-title":"Neurosurg Clin N Am"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/BRS.0000000000002741","article-title":"Rigid internal fixation for traumatic cranio-cervical dissociation in infants and young children","volume":"44","author":"J R Keen","year":"2019","journal-title":"Spine"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1159\/000056019","article-title":"Traumatic atlanto-occipital dislocation in children","volume":"34","author":"P Houle","year":"2001","journal-title":"Pediatr Neurosurg"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s00381-016-3265-1","article-title":"Traumatic atlanto-occipital dislocation in children-a case-based update on clinical characteristics, management and outcome","volume":"33","author":"T Beez","year":"2017","journal-title":"Childs Nerv Syst"},{"issue":"05","key":"ref20","doi-asserted-by":"crossref","first-page":"274","DOI":"10.5435\/JAAOS-22-05-274","article-title":"Traumatic atlanto-occipital dislocation in children","volume":"22","author":"N Astur","year":"2014","journal-title":"J Am Acad Orthop Surg"},{"issue":"02","key":"ref21","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1159\/000098389","article-title":"Occipito-atlanto-axial dissociation in a child with preservation of life: a case report and review of the literature","volume":"43","author":"J P Salinsky","year":"2007","journal-title":"Pediatr Neurosurg"},{"issue":"10","key":"ref22","doi-asserted-by":"crossref","first-page":"E421","DOI":"10.1097\/BRS.0b013e3181c91fa1","article-title":"Intraarticular atlantooccipital fusion for the treatment of traumatic occipitocervical dislocation in a child: a new technique for selective stabilization with nine years follow-up","volume":"35","author":"D Jeszenszky","year":"2010","journal-title":"Spine"},{"issue":"06","key":"ref23","doi-asserted-by":"crossref","first-page":"715.e17","DOI":"10.1016\/j.wneu.2011.12.079","article-title":"Occipitocervical fusion in an infant with atlantooccipital dislocation","volume":"78","author":"E C Benzel","year":"2012","journal-title":"World Neurosurg"},{"issue":"14","key":"ref24","doi-asserted-by":"crossref","first-page":"E424","DOI":"10.1097\/01.brs.0000170595.83169.94","article-title":"Redislocation in a halo vest of an atlanto-occipital dislocation in a child: recommendations for treatment","volume":"30","author":"G J van de Pol","year":"2005","journal-title":"Spine"},{"issue":"10","key":"ref25","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1007\/s00276-014-1274-x","article-title":"Applied anatomy of a minimally invasive muscle-splitting approach to posterior C1\u2013C2 fusion: an anatomical feasibility study","volume":"36","author":"G Bodon","year":"2014","journal-title":"Surg Radiol Anat"},{"issue":"05","key":"ref26","doi-asserted-by":"crossref","first-page":"E286","DOI":"10.1097\/BRS.0b013e318239cc7e","article-title":"New techniques for exposure of posterior cervical spine through intermuscular planes and their surgical application","volume":"37","author":"T Shiraishi","year":"2012","journal-title":"Spine"}],"container-title":["Journal of Neurological Surgery Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1760830.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T00:03:11Z","timestamp":1674604991000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1760830"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":26,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2023,1,16]]},"published-print":{"date-parts":[[2023,1]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1760830","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2193-6358","2193-6366"],"issn-type":[{"value":"2193-6358","type":"print"},{"value":"2193-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]}}}