Treatment of craniocervical spine lesion with osteogenesis imperfecta: a case report.
METHODS
A case report of craniocervical spine lesions including basilar impression, atlantoaxial dislocation, and syringomyelia, with osteogenesis imperfecta is presented, and the literature is reviewed.


OBJECTIVE
To discuss the problems involved in the surgical management of craniocervical spine lesion with osteogenesis imperfecta.


BACKGROUND
Osteogenesis imperfecta is known to have various spine lesions as complications. However, few reports have described craniocervical lesions associated with osteogenesis imperfecta.


METHODS
A 14-year-old girl with osteogenesis imperfecta, Silence classification IVB, experienced difficulty walking, with marked motor disturbance and muscle weakness in the extremities. Deep tendon reflexes were exaggerated bilaterally in the upper and lower extremities, and positive Babinski reflex and ankle clonus were observed bilaterally. Basilar impression, atlantoaxial dislocation, and syringomyelia were shown by plain radiography, tomography, three-dimensional computed tomography, and magnetic resonance imaging.


RESULTS
In the reported patient, posterior fossa decompression and atlantoaxial posterior fusion could not be performed because the foramen magnum and upper cervical spine invaginated to the base of the skull. Therefore, occipitocervical spine fusion using titanium loop and wires was performed at the reduced position of the atlantoaxial dislocation, resulting in improvement of neurologic deficits.


CONCLUSIONS
For patients with atlantoaxial dislocation, syringomyelia, and basilar impression without clinical symptoms or signs of brain stem compression, occipitocervical spine fusion alone at the reduction of the atlantoaxial dislocation may be indicated because these procedures improve neurologic deficits and prevent postoperative development of basilar impression and enlargement of syringomyelia.
Nakamura
Masahiro
M
Department of Orthopaedic Surgery, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
Yone
Kazunori
K
Yamaura
Ichiro
I
Ryoki
Yoshihiro
Y
Okano
Natsuko
N
Higo
Masaru
M
Komiya
Setsuro
S
D000293:Adolescent; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D018908:Muscle Weakness / Q000209:etiology; D010013:Osteogenesis Imperfecta / Q000150:complications*; D010985:Platybasia / Q000150:complications / Q000175:diagnosis*; D013123:Spinal Fusion / Q000379:methods*; D013595:Syringomyelia / Q000150:complications / Q000175:diagnosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome