DIAGNOSTIC: Standards There is insufficient evidence to support diagnostic standards. Guidelines There is insufficient evidence to support diagnostic guidelines. Options A lateral cervical x-ray is recommended for the diagnosis of atlanto-occipital dislocation. If a radiological method for measurement is used, the basion-axial interval-basion-dental interval method is recommended.The presence of upper cervical prevertebral soft tissue swelling on an otherwise nondiagnostic plain x-ray should prompt additional imaging.If there is clinical suspicion of atlanto-occipital dislocation, and plain x-rays are nondiagnostic, computed tomography or magnetic resonance imaging is recommended, particularly for the diagnosis of non-Type II dislocations. TREATMENT: Standards There is insufficient evidence to support treatment standards. Guidelines There is insufficient evidence to support treatment guidelines. Options Treatment with internal fixation and arthrodesis using one of a variety of methods is recommended. Traction may be used in the management of patients with atlanto-occipital dislocation, but it is associated with a 10% risk of neurological deterioration.
