Treatment of os odontoideum in a patient with spastic quadriplegic cerebral palsy.
Severe atlantoaxial instability due to os odontoideum in a patient with spastic cerebral palsy has not been well described. There is no consensus on treatment, particularly with regard to conservative or surgical options. Our patient was a 9-year-old girl with spastic cerebral palsy and unstable os odontoideum as an incidental finding. During the waiting period for elective surgical treatment, the patient developed respiratory compromise. Surgery was performed to reduce the subluxation and for C1-C2 arthrodesis and the girl regained baseline respiratory function. A CT scan was obtained 1 year after the initial surgery and revealed adequate maintenance of reduction and patency of the spinal canal. This patient highlights the fact that unstable os odontoideum can cause mortality due to respiratory distress in patients with spastic cerebral palsy. This is an important factor in deciding treatment options for cerebral palsy patients with low functional demand. We review the relevant literature.
Department of Orthopaedic Surgery, Loma Linda University, East Campus Ambulatory Services Building, Suite 213, 11406 Loma Linda Drive, Loma Linda, CA 92354, USA.
Yusuf T
YT
Akpolat
School of Medicine, Loma Linda University, Loma Linda, CA, USA.
Ben
B
Fegale
Department of Orthopaedic Surgery, Loma Linda University, East Campus Ambulatory Services Building, Suite 213, 11406 Loma Linda Drive, Loma Linda, CA 92354, USA. Electronic address: md4spine@yahoo.com.
Wayne K
WK
Cheng
D001268:Atlanto-Axial Joint / Q000601:surgery*; D002547:Cerebral Palsy / Q000150:complications* / Q000601:surgery / Q000628:therapy; D002648:Child; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology* / Q000601:surgery / Q000628:therapy*; D009460:Neurologic Examination; D009809:Odontoid Process / Q000601:surgery*; D011782:Quadriplegia / Q000150:complications* / Q000628:therapy; D011859:Radiography; D012131:Respiratory Insufficiency / Q000628:therapy; D013131:Spine / Q000000981:diagnostic imaging; D016896:Treatment Outcome
Atlanotoaxial dislocation; C1–C2 dislocation; C1–C2 subluxation; Cerebral palsy; Craniovertebral junction; Os odontoideum; Respiratory distress