title: Acute Traumatic Cervical Cord Injury in Pediatric Patients with os Odontoideum: A Series of 6 Patients.
abstract: OBJECTIVE
  Os odontoideum can lead to instability of the atlantoaxial joint and places the spinal cord at significant risk for acute traumatic catastrophic events or chronic neurologic change. The purpose of this study was to retrospectively review acute cervical cord injury after minor trauma in 6 pediatric patients with os odontoideum.
  
  
  METHODS
  Between 2012 and 2013, 6 pediatric patients with os odontoideum who suffered acute traumatic cervical cord injury were reviewed retrospectively. Their clinical history, neurologic symptoms, radiological investigations, follow-up period, American Spinal Injury Association (ASIA) impairment classification, and motor score were reviewed.
  
  
  RESULTS
  There were 2 male and 4 female subjects ranging in age from 4 to 18 years (mean 11.8 years). Before the traumatic injury, 2 cases were asymptomatic and 4 complained of myelopathic feature with unsteadiness on feet. Falls were the most common injury (n = 5), followed by a minor motor vehicle accident (n = 1). Atlantoaxial instability and cord compression were presented in all cases with dynamic cervical lateral radiographs and magnetic resonance imaging. Most patients presented with spinal cord thinning and hyperintensity on T2-weighted sequences in magnetic resonance imaging. Spinal cord compression was anterior in 2 cases and both anterior and posterior in 4. Two patients was classified as ASIA B, 1 as ASIA C, and 3 as ASIA D category on admission. Two patients presented with respiratory failure with mechanical ventilation for over 2 weeks in perioperative period. Postoperatively, all patients improved neurologically and clinically after underwent posterior atlantoaxial fixation and fusion.
  
  
  CONCLUSIONS
  Pediatric patients with asymptomatic or myelopathic atlantoaxial instability secondary to os odontoideum are at risk for acute spinal cord injury even after minor traumatic injury. Sufficient fixation and fusion should be undertaken as prophylactic treatment of developing myelopathy and to improve neurologic symptoms with acute traumatic cervical cord injury in pediatric patients with os odontoideum.
authors.affiliation: Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China. Electronic address: zhangz3@126.com.
authors.forename: Zhengfeng
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Honggang
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Liu
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001268:Atlanto-Axial Joint / Q000503:physiopathology / Q000601:surgery*; D066193:Cervical Cord / Q000293:injuries* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D009809:Odontoid Process / Q000601:surgery; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery; D013123:Spinal Fusion; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Cervical vertebrate; Os odontoideum; Pediatric; Spinal cord injury