Dynamic myelopathy as a result of C1 posterior arch aplasia and os odontoideum. A case report

Journal of Surgical Case Reports
Wen Jie ChoyRalph J Mobbs

Abstract

The atlas (C1) and axis (C2) have distinct morphologies to support the skull and facilitate head rotation and neck flexion. Congenital defects of C1 posterior arch are rare. We present a case of a 59-year-old man with both an absent C1 posterior arch with concomitant os odontoideum. The patient presented with neck crepitus, moderate neck pain and progressive worsening upper limbs paraesthesia and pain. Computed tomography (CT) revealed non-union between the odontoid process and body of axis as well as absence of C1 posterior arch. An occiput C0-C3 fusion was performed. The patient's symptoms improved significantly, and he is functioning well at 12 months. CT showed solid fusion without implant migration. Concomitant os odontoideum with aplastic C1 posterior arch is rare with limited evidence to guide management. Posterior fixation and fusion may be a potential solution to prevent dynamic compression, thereby preventing further myelopathy and related complications.

References

Oct 1, 1993·Skeletal Radiology·K A KirlewR H Gold
Apr 11, 2008·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Arnold H Menezes
Mar 5, 2010·Neurosurgery·Babak ArvinMichael G Fehlings
Aug 9, 2011·Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology·Charles Raybaud

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