{"id":"839480cd-628e-40ca-9621-b84850e728bc","slug":"management-of-traumatic-atlanto-occipital-dislocation-in-a-10-year-old-with-noninvasive-halo-immobilization-a-case-report","title":"Management of traumatic atlanto-occipital dislocation in a 10-year-old with noninvasive halo immobilization: A case report","authors":["Himanshu Shekhar","Marco Mancuso-Marcello","John Emelifeonwu","Pasquale Gallo","Drahoslav Sokol","Jothy Kandasamy","Chandrasekaran Kaliaperumal"],"abstract":"Background: Traumatic atlanto-occipital dislocation is an unstable injury of the craniocervical junction. For pediatric patients, surgical arthrodesis of the occipitocervical junction is the recommended management. While having a high success rate for stabilization, the fusion comes with obvious morbidity of limitation in cervical spine flexion, extension, and rotation. An alternative is external immobilization with a conventional halo. Case Description: We describe the case of a 10-year-old boy who was treated successfully for traumatic AOD with a noninvasive pinless halo. Following initial brain trauma management, we immobilized the craniocervical junction with a pinless halo after reducing the atlanto-occipital dislocation. The pinless halo was kept on at all times for the next 3 months. The craniocervical junction alignment was monitored with weekly cervical spine X-rays and CT craniocervical junction on day 15th, day 30th, and day 70th. A follow-up MRI C-spine 3 months from presentation confirmed resolution of the soft-tissue injury and the pinless halo was removed. Dynamic cervical spine X-rays revealed satisfactory alignment in both flexion and extension views. The patient has been followed up for 2 years postinjury and no issues were identified. Conclusion: Noninvasive pinless halo is a potential treatment option for traumatic pediatric atlanto-occipital dislocation. This should be considered bearing in mind multiple factors including age and weight of the patient, severity of the atlanto-occipital dislocation (Grade I vs. Grade II and incomplete vs. complete), concomitant skull and scalp injury, and patient’s ability to tolerate the halo. It is vital to emphasize that this necessitates close clinicoradiological monitoring.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/839480cd-628e-40ca-9621-b84850e728bc/featured/hero-1781561316933.png","publishDate":"2022-05-27T00:00:00.000Z","doi":"10.25259/SNI_17_2022","categories":["Pediatric Neurosurgery","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2022/05/11621/SNI-13-222.pdf"}