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Study Design Case series with surgical technical note. Objectives This article reports experiences and results of muscle-preserving temporary C0-C2 fixation for the treatment of atlanto-occipital dislocation (AOD). Methods AOD 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. Results We 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 degrees of C1-C2 rotation.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 degrees. Conclusion C0-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.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.

Introduction: Traumatic posterior occipitocervical dissociation (OCD) is a rare injury, and only a few cases have been reported in the literature. The diagnosis can be delayed or even missed because of its uncommon presentation. We present this rare case report and its management to highlight this unusual injury to increase the awareness of the existence of this pathology and prevent delayed diagnosis and treatment. Case Report: A 76-year-old man was brought to the emergency room with complaints of neck pain. There was a history of trivial trauma before this complaint. The cervical spine images revealed an anterior subluxation of the cervical spine with Jefferson burst fracture involving bilateral fractures of anterior and posterior arches, C5-6 transdiscal fracture, underlying ossification of the posterior longitudinal ligament (OPLL), and diffuse idiopathic skeletal hyperostosis (DISH). He was managed with closed reduction, occipitocervical fourth vertebra fusion (O-C4), and C1, C2 laminectomies with a good outcome. Conclusion: Traumatic OCD can result from low-energy trauma. We report a rare case of posterior OCD that was associated with Jefferson fracture and predisposing factors, including OPLL and DISH.