Case ReportAcute Traumatic Cervical Cord Injury in Pediatric Patients with os Odontoideum: A Series of 6 Patients
Introduction
Os odontoideum is an abnormality of the upper cervical spine in which the odontoid process is a separate ossicle from the body of the axis. This abnormality occurs as a result of a congenital defect or trauma and also may result from fracture of the odontoid synchondrosis before closure at 5–6 years of age. Os odontoideum can lead to instability of the atlantoaxial joint, placing the spinal cord at significant risk for acute catastrophic events. Several authors have reported detailed series of patients with os odontoideum who do not have a history of trauma 11, 13, 30, 31. Trauma has been clearly noted to be a contributing factor in both adult and pediatric patients 6, 8, 9, 10, 15, 23. However, acute traumatic severe cervical cord injury has not been reported in pediatric patients with os odontoideum. We present 6 pediatric cases with os odontoideum who experienced acute cervical cord injury as a result of minor trauma. The purpose of this study was to review retrospectively our experience of acute cervical cord injury and to evaluate surgical management in pediatric patients.
Section snippets
Materials and Methods
Between 2012 and 2013, 17 patients with os odontoideum were admitted to the investigator's group (Z.Z.). We retrospectively reviewed 6 pediatric patients with trauma who had been managed initially by the emergency department and were transferred for surgery because of os odontoideum and acute spinal cord injury. Eleven adult patients were excluded from the study because they presented with progressive neurologic injury without cervical trauma. There were 2 male and 4 female patients ranging in
Results
Clinical data are summarized in Table 1 and Figure 1. All patients had no history of cervical trauma. Before the traumatic injury, 2 patients were asymptomatic and 4 patients had experienced neurologic symptoms with unsteadiness on feet. Falls accounted for the trauma in 5 patients and motor vehicle accident in 1. Falling down at a sports class was the most common in patients with unsteadiness on feet (4 cases). For the patient (case 3) who involved in motor vehicle accident, injury was
Illustrative Patient (Case 4)
An 11-year-old girl was admitted with quadriparesis after a minor cervical injury that occurred after a fall to the ground at a sports class. Neurologic examination revealed bilateral upper limb and lower limbs weakness (ASIA B). Findings of the CT scan revealed os odontoideum, atlantoaxial instability, and spinal cord compression from posterior and anterior. This abnormality was not reported initially in her previous hospital records; however, she complained unsteadiness on her feet
Discussion
Atlantoaxial instability secondary to os odontoideum leads to a high risk of potential acute spinal cord injury after minor trauma. Previously, os odontoideum was not able to be well illustrated on cervical spine radiographs, and it was reported to cause fatal high cervical spinal cord injury and death after a low-speed collision in several previously healthy patients without apparent injury 19, 20. A delay in diagnosis is not uncommon because patients often are asymptomatic or present with
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.