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Chronic posterior atlantoaxial subluxation associated with os odontoideum: a rare condition. A case report and literature review.
Spinal Cord Series and Cases ( IF 0.7 ) Pub Date : 2018-12-19 , DOI: 10.1038/s41394-018-0143-y Tinnakorn Pluemvitayaporn 1 , Sombat Kunakornsawat 1 , Chaiwat Piyaskulkaew 1 , Pritsanai Pruttikul 1 , Warongporn Pongpinyopap 1
Spinal Cord Series and Cases ( IF 0.7 ) Pub Date : 2018-12-19 , DOI: 10.1038/s41394-018-0143-y Tinnakorn Pluemvitayaporn 1 , Sombat Kunakornsawat 1 , Chaiwat Piyaskulkaew 1 , Pritsanai Pruttikul 1 , Warongporn Pongpinyopap 1
Affiliation
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Introduction
Os odontoideum is a rare cervical lesion. This unusual condition is sometimes associated with atlantoaxial subluxation, which is mostly anterior subluxation. Posterior atlantoaxial subluxation due to os odontoideum is extremely rare.
Case presentation
We report an unusual case of a 60-year-old Thai female, who was diagnosed as having chronic posterior atlantoaxial subluxation associated with os odontoideum with progressive myelopathy. The patient underwent posterior arch of C1 laminectomy and an occipito-C3 fusion using an occipital plate, C2 pedicle screws, C3 lateral mass screws and autologous iliac crest strut bone graft arthrodesis. During three years of follow-up, she was clinically significantly improved and postoperative radiographs showed a solid osseous fusion without loss of correction or implant failure.
Discussion
Chronic posterior atlantoaxial subluxation associated with os odontoideum is rare. This condition can cause occipital-cervical pain, myelopathy, intracranial symptoms, or death. Surgical decompression and stabilization is the treatment of choice. Principles of treatment are to prevent sudden death from neurological compromise, improve neurological status, stabilize the cervical spine, and improve quality of life. Surgical options include atlantoaxial fusion, occipito-C2 fusion, and occipito-C3 fusion. Decision making depends on the location of spinal cord compression, area for arthrodesis, and bone quality.
中文翻译：
与齿状骨相关的慢性寰枢椎后半脱位：一种罕见疾病。病例报告和文献综述。
简介 齿状骨是一种罕见的宫颈病变。这种不寻常的情况有时与寰枢椎半脱位有关，其中大多数是前半脱位。齿状骨引起的寰枢椎后半脱位极为罕见。病例介绍 我们报道了一名 60 岁泰国女性的罕见病例，她被诊断患有与齿状骨相关的慢性寰枢椎后半脱位并伴有进行性脊髓病。该患者接受了 C1 后弓椎板切除术和枕骨-C3 融合术，使用枕骨板、C2 椎弓根螺钉、C3 侧块螺钉和自体髂嵴支柱骨移植关节固定术。在三年的随访中，她的临床症状显着改善，术后X光片显示骨融合牢固，没有矫正失败或种植失败。讨论 与齿状骨相关的慢性寰枢椎后半脱位很少见。这种情况可能导致枕颈疼痛、脊髓病、颅内症状或死亡。手术减压和稳定是首选治疗方法。治疗原则是预防神经损害引起的猝死，改善神经状态，稳定颈椎，提高生活质量。手术选择包括寰枢椎融合术、枕骨-C2 融合术和枕骨-C3 融合术。决策取决于脊髓受压的位置、关节固定术的区域和骨质量。
更新日期：2019-05-16
中文翻译：
与齿状骨相关的慢性寰枢椎后半脱位：一种罕见疾病。病例报告和文献综述。
简介 齿状骨是一种罕见的宫颈病变。这种不寻常的情况有时与寰枢椎半脱位有关，其中大多数是前半脱位。齿状骨引起的寰枢椎后半脱位极为罕见。病例介绍 我们报道了一名 60 岁泰国女性的罕见病例，她被诊断患有与齿状骨相关的慢性寰枢椎后半脱位并伴有进行性脊髓病。该患者接受了 C1 后弓椎板切除术和枕骨-C3 融合术，使用枕骨板、C2 椎弓根螺钉、C3 侧块螺钉和自体髂嵴支柱骨移植关节固定术。在三年的随访中，她的临床症状显着改善，术后X光片显示骨融合牢固，没有矫正失败或种植失败。讨论 与齿状骨相关的慢性寰枢椎后半脱位很少见。这种情况可能导致枕颈疼痛、脊髓病、颅内症状或死亡。手术减压和稳定是首选治疗方法。治疗原则是预防神经损害引起的猝死，改善神经状态，稳定颈椎，提高生活质量。手术选择包括寰枢椎融合术、枕骨-C2 融合术和枕骨-C3 融合术。决策取决于脊髓受压的位置、关节固定术的区域和骨质量。
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