Chronic Neck Pain Associated with an Old Odontoid Fracture: A Rare Presentation

Avila, Mauricio J.

doi:10.1155/2013/372723

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…5 Furthermore, fractures of the odontoid process are usually more common in the elderly and may go unnoticed due to a lack of neurological deficit. 6 Odontoid fractures are known to predispose toward atlantoaxial instability. 7 In this case, the type II fracture of the dens was an old injury.…”

Section: Introductionmentioning

confidence: 99%

Traumatic Atlantoaxial Lateral Subluxation With Chronic Type II Odontoid Fracture: A Case Report

et al. 2019

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Background: We report a case of an elderly patient who was diagnosed with lateral atlantoaxial subluxation with type II odontoid fracture, an extremely uncommon upper cervical spine injury that has not been previously reported in the literature to the knowledge of the authors. Methods: An 87-year-old male reported to the emergency room following a syncopal episode after sustaining a fall. He complained of dizziness, fatigue, disruption of vision and audition, and worsening neck pain. Computed tomographic scans were positive of partial dislocation of the C1 relative to C2 and chronic fracture of dens classified as type II according to the Anderson and D'Alonzo classification system. Magnetic resonance imaging further revealed large fracture pannus tissue at the level of the dens, reducing the space in the spinal cord. There was no evidence of spinal cord injury. Atlas-axis fusion with instrumentation was performed to manage the injury. A review of the classification, occurrence, and management of upper cervical spine surgeries was performed. Results: An acute injury to a previously unrecognized type II odontoid fracture with partial C1-C2 dislocation was identified as a rare upper cervical spine injury and classified based on the Anderson and D'Alonzo and Fielding and Hawkins classification systems. The decision was made to perform instrumented spinal fusion by inserting mass screws into C1, pars screws into C2, and locking rods to realign the vertebral bodies and address the atlantoaxial instability. Follow-up scans indicated good postsurgical reduction and fixation, including resolution of the pannus overgrowth without direct intervention. Conclusions: Lateral atlantoaxial subluxation with chronic type II fracture of the dens constitutes a rare injury of the upper cervical vertebrae. Posterior instrumented spinal fusion was used to effectively manage the injury, leading to reabsorption of retro-odontoid pannus tissue.

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Section: Introductionmentioning

confidence: 99%

Traumatic Atlantoaxial Lateral Subluxation With Chronic Type II Odontoid Fracture: A Case Report

et al. 2019

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“…The hazards of nonunited odontoid fractures in adults can include mechanical neck pain[ 2 ] as well as progressive craniocervical deformity[ 5 8 ] and neurological deterioration into cervical myelopathy. [ 4 5 6 7 8 9 11 12 ] Minor delayed trauma may also lead to substantial clinical progression.…”

Section: Introductionmentioning

confidence: 99%

Chronic hypertrophic nonunion of the Type II odontoid fracture causing cervical myelopathy: Case report and review of literature

et al. 2016

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Background:Complications of nonunited Type II odontoid fractures can range from neck pain to progressive neurological deficit from cervical myelopathy. Rarely, the hypertrophic nonunion requires both anterior transoral decompression and posterior decompression with instrumented fusion. We present a case and review literature around this entity.Case Description:A 68-year-old female presented with rapidly progressive cervical myelopathy (from normal to moderate myelopathy modified Japanese Orthopedic Association [mJOA] 13) over 3 months. Her history was positive for a Type II odontoid fracture managed conservatively and lost to follow-up for 25 years. Spinal imaging studies revealed hypertrophic nonunion and craniocervical kyphotic deformity with significant subaxial stenosis and segmental kyphosis. The patient underwent anterior transoral decompression, followed by posterior occipitothoracic decompression and instrumented fusion. At follow-up, the cervical myelopathy has improved to near normalcy (mJOA 17) with no evidence or implant-related complication.Conclusion:Rarely, nonunion of Type II odontoid fractures may be hypertrophic where both instability and compression cause neurological morbidity. Such cases require anterior transoral decompression, posterior cervical decompression, and instrumented fusions.

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“…This patient's case highlights the hazards of nonunited odontoid fractures in adults. Rarely, such pseudoarthrosis may predispose the patient to mechanical neck pain 1 and progressive craniocervical deformity. 2 The association with progressive cervical myelopathy and the appropriate surgical remedy for when it occurs remains undefined.…”

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confidence: 99%