Multidirectional atlantoaxial instability of an os odontoideum in an adult

Der Unfallchirurg
J IsenbergU Hahn

Abstract

Increasing neck pain in a 29 year old woman after a frontal car collision gave reason for a conventional x-ray that presented a traumatically displaced os odontoideum positioned at the top of the dens axis. No neurological defect was seen. Dynamic flexion/extension film showed a movement to an atlantoaxial dislocation with a shift of the os odontoideum. The sclerotic structure of the corresponding bony surfaces was confirmed by computed tomography, whereas magnetic resonance imaging demonstrated a posttraumatic signal change in front of the base of dens axis and os odontoideum. Fusion was achieved by computed navigation with C1/C2 transfacetal screws as described by Magerl and interspinal fusion with a bicortical autologous iliac crest graft and a posterior tension band as described by Brooks. An exact positioning of screws past the asymmetric course of both arteria vertebrales was possible by navigation. The patient was free of pain 5 months after the fusion.

References

Mar 15, 1997·Spine·J M Verska, P A Anderson
Nov 5, 1997·Journal of Neurosurgery·D W LowryP D Adelson
Nov 20, 1998·Journal of Pediatric Orthopedics·L R KuhnsR N Hensinger
Jan 9, 2001·Journal of Neurosurgery·H SakaidaT Matsubara

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Citations

Sep 19, 2009·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Thorsten TjardesHolger Baethis

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