Atlantoaxial subluxation-induced myelopathy in cleidocranial dysplasia. Case report.
The authors describe the clinical course and treatment of a patient with cleidocranial dysplasia in whom spastic myelopathy developed due to atlantoaxial subluxation. This 27-year-old woman with cleidocranial dysplasia and a history of atlantoaxial subluxation presented with spastic myelopathy. Surgery was performed twice for cervical myelopathy and atlantoaxial subluxation, including laminectomy at the atlas and cervicooccipital fusion in which the Luque rod system was used, as well as C1-2 fusion via the transpharyngeal route. Solid bone fusion was achieved by 7 months postsurgery. Postoperative magnetic resonance imaging studies demonstrated that spinal cord compression was relieved, but atrophy persisted. At 2 years postsurgery there was no neurological disease progression, but spasticity persisted. The patient could walk with a cane. Cleidocranial dysplasia is an extremely rare cause of myelopathy in patients with atlantoaxial subluxation; the authors know of only two reports of this condition. When managing cleidocranial dysplasia, the practitioner should always be aware that atlantoaxial subluxation may be the cause of cervical myelopathy.
Department of Orthopaedics and Rehabilitation Medicine, Fukui University School of Medicine, Fukui, Japan. kshigeru@fmsrsa.fukui-med.ac.jp
Shigeru
S
Kobayashi
Kenzo
K
Uchida
Hisatoshi
H
Baba
Kenichi
K
Takeno
Takasi
T
Yayama
Hideaki
H
Nakajima
Eiki
E
Nomura
Hidezo
H
Yoshizawa
D000328:Adult; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000473:pathology; D001858:Bone Nails; D001270:Cervical Atlas / Q000601:surgery; D002574:Cervical Vertebrae / Q000601:surgery; D002973:Cleidocranial Dysplasia / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D009128:Muscle Spasticity / Q000209:etiology*; D009777:Occipital Bone / Q000601:surgery; D011859:Radiography; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery; D013118:Spinal Cord Diseases / Q000209:etiology* / Q000601:surgery; D013123:Spinal Fusion; D016896:Treatment Outcome