Zygourakis Corinna C, Cahill Kevin S, Proctor Mark R
Department of Neurosurgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
J Neurosurg Pediatr. 2011 Feb;7(2):201-4. doi: 10.3171/2010.11.PEDS10289.
A previously healthy 2-year-old girl sustained a C1-2 ligamentous injury after a motor vehicle accident and underwent successful halo immobilization, with postimmobilization images showing good cervical alignment. At the time, plain radiography, CT scanning, and MR imaging showed a normal odontoid. Four years later, however, the patient was found to have an os odontoideum, evident on plain radiography and CT imaging. At the 10-year follow-up, the os odontoideum had not been surgically repaired, and the child had mild hypermobility. This is the first documented case in the modern imaging era of delayed os odontoideum formation after definitive CT scanning showed no fracture. As such, this suggests that os odontoideum may result from traumatic vascular interruption in the developing spine, with resulting osseous remodeling leading to an os odontoideum. This case argues against the congenital etiology of os odontoideum, as well as the strict posttraumatic theory whereby a trauma-induced odontoid fracture leads to osseous remodeling and subsequent development of an os odontoideum.
一名既往健康的2岁女童在机动车事故后发生C1-2韧带损伤，接受了成功的头环固定，固定后影像显示颈椎排列良好。当时，X线平片、CT扫描和磁共振成像显示齿状突正常。然而，4年后，患者被发现有齿突骨，在X线平片和CT成像上很明显。在10年随访时，齿突骨未进行手术修复，患儿有轻度活动过度。这是现代影像学时代首例经明确的CT扫描显示无骨折后延迟形成齿突骨的记录病例。因此，这表明齿突骨可能是由于发育中的脊柱创伤性血管中断，导致骨质重塑从而形成齿突骨。该病例反对齿突骨的先天性病因，以及认为创伤性齿突骨折导致骨质重塑并随后发展为齿突骨的严格创伤后理论。
