title: Unilateral osseous bridging between the arches of atlas and axis after trauma.
abstract: METHODS
  This is a case report.
  
  
  OBJECTIVE
  To present a case of osseous bridging between C1 and C2 of posttraumatic origin and with an associated closed head injury and to discuss its pathogenesis and clinical outcome after surgical resection.
  
  
  BACKGROUND
  Heterotopic ossifications of posttraumatic origin in the spine are rare. To the authors' knowledge, no cases have been reported of spontaneous bony bridging between C1 and C2 with a posttraumatic origin.
  
  
  METHODS
  Heterotopic ossifications were detected when pain and limited axial rotation (left/right 10 degrees/0 degree/20 degrees) were persistent, despite intensive physical therapy. Because heterotopic ossifications were ankylosing C1 and C2, the decision was to resect the osseous bridge in combination with a careful mobilization of the cervical spine. Functional computed tomography was performed for analysis of the postoperative results.
  
  
  RESULTS
  Four months after surgery, clinical examination showed asymptomatic increased axial rotation. Functional computed tomography indicated that left C1-C2 axial rotation was reduced, possibly related to impingement caused by residual bony spurs. Pathologic changes in the surrounding soft tissue may be another important factor in the persistent limitation of rotation.
  
  
  CONCLUSIONS
  Osseous bridging between C1 and C2 may be considered when persistent pain and limited axial rotation are observed after trauma. Operative resection, together with careful intraoperative and postoperative mobilization, may be the treatment of choice.
authors.affiliation: Department of Trauma Surgery, Medizinische Hochschule Hannover, Germany. ormdie@krzsun.med-rz.uni-sb.de
authors.forename: M
authors.initials: M
authors.lastname: Dienst
authors.forename: C
authors.initials: C
authors.lastname: Engelke
authors.forename: M
authors.initials: M
authors.lastname: Prokop
authors.forename: M
authors.initials: M
authors.lastname: Blauth
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis; D000063:Accidents, Traffic; D000328:Adult; D001368:Axis, Cervical Vertebra / Q000293:injuries / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D001270:Cervical Atlas / Q000293:injuries / Q000601:surgery*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D006259:Craniocerebral Trauma / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery; D009999:Ossification, Heterotopic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods; D013167:Spondylitis, Ankylosing / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013898:Thoracic Injuries / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000601:surgery