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

Surgical Neurology International
Mohammed F ShamjiMichael G Fehlings

Abstract

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. 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. 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 cerv...Continue Reading

References

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Citations

Oct 1, 2016·Current Reviews in Musculoskeletal Medicine·Megan E Gornet, Michael P Kelly
Jul 4, 2020·British Journal of Neurosurgery·Vladimir KlimovJamil Rzaev
Oct 3, 2018·The Journal of Spinal Cord Medicine·Wei WangMingsheng Tan
Sep 19, 2019·Surgical Neurology International·Sanaullah Khan BashirGohar Javed
Oct 5, 2021·Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews·Dong-Gune ChangHong Jin Kim

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