[Multidirectional atlantoaxial instability of an os odontoideum in an adult].
Increasing neck pain in a 29 year old woman after a frontal car collision gave reason for a conventional x-ray that presented a traumatically displaced os odontoideum positioned at the top of the dens axis. No neurological defect was seen. Dynamic flexion/extension film showed a movement to an atlantoaxial dislocation with a shift of the os odontoideum. The sclerotic structure of the corresponding bony surfaces was confirmed by computed tomography, whereas magnetic resonance imaging demonstrated a posttraumatic signal change in front of the base of dens axis and os odontoideum. Fusion was achieved by computed navigation with C1/C2 transfacetal screws as described by Magerl and interspinal fusion with a bicortical autologous iliac crest graft and a posterior tension band as described by Brooks. An exact positioning of screws past the asymmetric course of both arteria vertebrales was possible by navigation. The patient was free of pain 5 months after the fusion.
Isenberg
J
J
Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universität, Köln. isenbergajem@aol.com
Andermahr
J
J
Hahn
U
U
D000328:Adult; D001268:Atlanto-Axial Joint / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D004204:Joint Dislocations / Q000175:diagnosis / Q000601:surgery*; D007593:Joint Instability / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D009809:Odontoid Process / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis; D013123:Spinal Fusion; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface