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Surgical treatment of chronic C1-2 dislocation with absence of odontoid process using C1 hooks with C2 pedicle screws: A case report and review of literature.
MedLine Citation:
PMID:  21358484     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Study Design. Case report.Objective. Here we present a rare case of chronic C1-2 dislocation with absence of odontoid process that underwent posterior C1-2 arthrodesis using C1 hooks and C2 pedicle screws.Summary of Background Data. C1-2 dislocation is a rare but fatal upper cervical injury. To date, there have been many reports about C1-2 dislocation of traumatic origin. However, very few C1-2 dislocation cases of congenital odontoid deformities had been presented. This was particularly the case when the odontoid process was absent.Methods. Plain radiograph of his cervical spine revealed a C1-2 dislocation, and subsequent CT scan as well as MRI imaging detected absence of odontoid process and cord compression. Upon admission, the patient was placed on skull traction and the weight increased from 3.5kg to 5.5kg. After 10 days of traction, reduction was achieved radiographically and the posterior C1-2 arthrodesis by C1 hooks with C2 pedicle screws was performed.Results. After surgery, the patient showed significant improvement in gait function despite slightly raised muscle tone in his lower extremities. Four-month postoperative radiographs indicated restoration of C1-2 alignment and bony fusion. No residual cord compression was present.Conclusion. In clinical evaluation of patients who present with neck pain, limited cervical motion with or without neurologic deficits, C1-2 dislocation should be taken into consideration. If the patient has no history of trauma or infection, congenital C1-2 deformity, especially odontoid malformation, has to be included as a possible factor. Once the diagnosis is confirmed, posterior C1-2 arthrodesis may become necessary for stabilizing C1-2 and preventing it from deterioration or new development of neurologic symptoms.
Authors:
Xue Feng Li; Wei Min Jiang; Hui Lin Yang; Tian Si Tang; Xiao Hong Gong; Jing Yuan; Genlin Wang
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-24
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-3-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Orthopedics Department, The First Affiliated hospital of Soochow University. 188 shizi street, Suzhou 215006, China.
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