Craniocervical dissociation: A framework for diagnosis and management of a rare but never miss injury

Craniocervical dissociation (CCD) is a potentially devastating injury resulting from osseoligamentous injury to the craniovertebral junction and is associated with significant neurologic morbidity and mortality. CCD may be difficult to diagnose due to subtle imaging findings, and delayed diagnosis can lead to further neurologic decline. CCD is a surgical emergency and should be securely stabilized until definitive surgical rigid internal fixation can be performed. The current article will provide a framework for the management of CCD, with a particular emphasis on the critical first step of diagnosis.