IS Case 383: Atlanto-occipital dislocation

Parul Patel, MD

2009 URMC Imaging Sciences
Publication Date: 2010-03-02


Patient is an 18-year-old woman status post-motor vehicle crash. Patient was the unrestrained backseat passenger and was ejected from the vehicle.


Complete atlanto-occipital dislocation.


Atlanto-occipital dislocation


Atlanto-occipital injuries range from complete atlanto-occipital or atlantoaxial dislocation to non-displaced occipital condyle avulsion fractures. The articulations of the craniocervical junction are defined by the middle atlantoaxial joint (which allows rotation of C1 and C2), and the paired lateral atlantoaxial and atlanto-occipital articulations. Injuries of the upper cervical spine occur most frequently in fatal motor vehicle accidents with the likely mechanism including violent distractive hyperflexion or hyperextension. Normal measurements for several of the bone relationships at the craniocervical junction have been determined and are useful in excluding upper cervical spine injury and are summarized below:

  • Lateral atlanto-dens articulation < 2-3mm side to side difference

  • Atlantoaxial articulation 2-3mm


  1. Deliganis AV, Baxter AB, Hanson JA, et al. Radiologic spectrum of craniocervical distraction injuries. Radiographics. 2000 Oct;20 Spec No:S237-50. PMID: 11046174

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