Atlanto-Axial Deformity Secondary to a Neglected Odontoid Fracture: A Report of Six Cases

Ho, Angela W. H.; Ho, Yuen-Fong

doi:10.1177/230949901001800220

Cited by 8 publications

(10 citation statements)

References 16 publications

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“…The sparse literature surrounding the management of such hypertrophic deformity is summarized in Table 1 with the reports spanning 22 years and including four patients of diverse ages and with variable delays between trauma and neurological deterioration. [ 5 8 ] The challenge when applying any algorithm such as that advocated by Kirankumar et al . [ 9 ] to the patient with hypertrophic disease is notably that the neurological safety of fully reducing the deformity must be considered.…”

Section: Discussionmentioning

confidence: 99%

“…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. [ 3 ] The appropriate management once a pseudoarthrosis is identified, is undefined.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…Delayed or improper treatment of odontoid fractures may result in nonunion or malunion, and subsequent C1-C2 instability or dislocation can lead to cervical spinal cord injury, causing upper-and lower-limb symptoms, breathing difficulty, and other life-threatening symptoms. [6][7][8][9] Several surgical strategies for odontoid fractures and C1-C2 instability are available, including external fixation, anterior screw fixation, and posterior C1-C2 fusion. However, the effectiveness of these strategies is controversial.…”

Section: Introductionmentioning

confidence: 99%

C1–C2 Pedicle Screw Fixation for Treatment of Old Odontoid Fractures

Lei¹,

Zhang²,

Si³

et al. 2015

Orthopedics

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Nonunion and C1-C2 instability of odontoid fractures usually result from delayed diagnosis and inappropriate treatment. However, the available treatment options for odontoid fractures remain controversial. The authors evaluated the effectiveness of internal screw fixation via the C1 and C2 pedicle in cases of old odontoid fractures. This retrospective study included 21 patients with old odontoid fractures (13 men and 8 women; mean age, 46.5 years; range, 24-69 years). Internal screw fixation via the C1 and C2 pedicle was performed in all patients. Fracture reduction and C1-C2 fusion were assessed with imaging. The neck pain visual analog scale score and cervical spinal cord functional Japanese Orthopaedic Association score (for those who had cervical spinal cord injury) were used to evaluate the effectiveness of treatment. Postoperative complications were recorded. Postoperative imaging showed that the C1-C2 dislocation was satisfactorily repositioned in all patients. Bone fusion was observed 1 year after surgery in all patients. No loosening or breaking of internal fixation occurred. The preoperative neck pain visual analog scale score was 5.9±1.5 and improved significantly to 1.8±0.8 after surgery (P<.001). The Japanese Orthopaedic Association score in patients with cervical spinal injury (n=14) was 9.2±1.9 and also significantly improved to 13.8±1.9 at the last follow-up examination (P<.001), with an average improvement rate of 61.0%. No iatrogenic vertebral artery injury or severe spinal cord injury occurred. Screw fixation via the C1 and C2 pedicle was found to be an effective and safe surgical approach for the treatment of old odontoid fractures with C1-C2 dislocation or instability.

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“…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. Close follow-up after either conservative or surgical management remains important to protect these patients from delayed complications.…”

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confidence: 99%