[Medical-insurance aspects of atlantoaxial instability in children].
BACKGROUND
An os odontoideum is mostly diagnosed coincidentally on the basis of neurological symptoms or painful movement of the cervical spine. Diagnostic work-up and therapy are currently subjects of controversial discussion in the literature.


METHODS
Our report is about an eleven-year-old boy with an unknown os odontoideum, who developed neurological symptoms with tetraparesis after a fall from 1.5 m height. Conventional X-ray examination resulted in the diagnosis of a suspected dens fracture, MRI showed atlanto-axial instability and an os odontoideum with significant dural sack compression but no signs of acute bony or ligamentous lesion.


CONCLUSIONS
Because of the importance concerning not only medical but also legal/insurance aspects, a possible coincidental finding of an os odontoideum versus a dens fracture must be included in the differential diagnosis. In the case of an os odontoideum without instability in children, conservative therapy is justified after due enlightenment regarding possible risks. In the event of neurological symptoms and/or persistent instability the authors advocate early surgical stabilization even in patients with little infirmity, particularly in view of the possible consequences.
Wild
A
A
Orthopädische Universitätsklinik Düsseldorf, Germany. wild@med.uni-duesseldorf.de
Jäger
M
M
Fuss
M
M
Werner
A
A
Krauspe
R
R
D000058:Accidental Falls; D001268:Atlanto-Axial Joint / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D002648:Child; D003937:Diagnosis, Differential; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000151:congenital / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D009809:Odontoid Process / Q000002:abnormalities* / Q000293:injuries / Q000473:pathology / Q000601:surgery; D011782:Quadriplegia / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000601:surgery; D016103:Spinal Fractures / Q000175:diagnosis*; D013123:Spinal Fusion