title: Sudden onset odontoid fracture caused by cervical instability in hypotonic cerebral palsy.
abstract: Fractures of the upper cervical spine rarely occur but carry a high rate of mortality and neurological disabilities in children. Although odontoid fractures are commonly caused by high-impact injuries, cerebral palsy children with cervical instability have a risk of developing spinal fractures even from mild trauma. We herein present the first case of an odontoid fracture in a 4-year-old boy with cerebral palsy. He exhibited prominent cervical instability due to hypotonic cerebral palsy from infancy. He suddenly developed acute respiratory failure, which subsequently required mechanical ventilation. Neuroimaging clearly revealed a type-III odontoid fracture accompanied by anterior displacement with compression of the cervical spinal cord. Bone mineral density was prominently decreased probably due to his long-term bedridden status and poor nutritional condition. We subsequently performed posterior internal fixation surgically using an onlay bone graft, resulting in a dramatic improvement in his respiratory failure. To our knowledge, this is the first report of an odontoid fracture caused by cervical instability in hypotonic cerebral palsy. Since cervical instability and decreased bone mineral density are frequently associated with cerebral palsy, odontoid fractures should be cautiously examined in cases of sudden onset respiratory failure and aggravated weakness, especially in hypotonic cerebral palsy patients.
authors.affiliation: Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Pediatrics, Asahi General Hospital, Chiba, Japan. Electronic address: asuha_hare@yahoo.co.jp.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Shiohama
authors.forename: Katsunori
authors.initials: K
authors.lastname: Fujii
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Kitazawa
authors.forename: Akiko
authors.initials: A
authors.lastname: Takahashi
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Maemoto
authors.forename: Akihito
authors.initials: A
authors.lastname: Honda
mesh_terms: D002547:Cerebral Palsy / Q000150:complications* / Q000473:pathology; D002574:Cervical Vertebrae / Q000293:injuries*; D002675:Child, Preschool; D006801:Humans; D008297:Male; D009809:Odontoid Process / Q000293:injuries*; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology