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Occipitocervical Dissociation S13.111A

 

Spinal Cord Anatomy

Upper Extremity innervationLower extremity Cutaneous Innervation

synonyms:

Occipitocervical Dissociation ICD-10

Occipitocervical Dissociation Etiology / Epidemiology / Natural History

  • High energy trauma
  • Often fatal

Occipitocervical Dissociation Anatomy

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Occipitocervical Dissociation Clinical Evaluation

  • Palpate entire spine for tenderness / step off.
  • Complete neuro exam: motor strength, pin-prick sensation, reflexes, cranial nerves, rectal examination (perineal pin-prick sensation, sphincter tone, volitional spincter control)
  • Absence of the bulbocaverosus reflex indicates spinal shock. Level of spinal injury can not be determined until bulbocaverosus reflex has returned.
  • See ASIA form.

Occipitocervical Dissociation Xray / Diagnositc Tests

  • A/P, Lateral, Odontoid: findings may be suttle, evaluate relationship of occipute to the Atlas, small avulsion fractures, soft-tissue swelling
  • CT cervical spine:
  • MRI: i

Occipitocervical Dissociation Classification / Treatment

  • Immediate reduction with halo vest placement indicated followed by insturmented arthrodesis. (Vaccaro AR, Injury 2005;35(suppl 2):B44).

Occipitocervical Dissociation Associated Injuries / Differential Diagnosis

  • C-Spine Trauma Differential Diagnosis
  • Brainstem injury
  • Vertebrobasilar arterial injury
  • Subarachnoid hemorrhage
  • Posterior pharyngeal wall disruption
  • Head injury
  • Skull base fracutres
  • Lower cranial nerve palsies (CN12)
  • Upper cervical spine injuries

Occipitocervical Dissociation Complications

Occipitocervical Dissociation Follow-up Care

Occipitocervical Dissociation Review References

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