Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
World Neurosurg. 2015 Jun;83(6):1180.e1-6. doi: 10.1016/j.wneu.2014.12.036. Epub 2014 Dec 19.
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.
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.
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.
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.
齿状突可导致寰枢关节不稳定，使脊髓面临急性创伤性灾难性事件或慢性神经功能改变的巨大风险。本研究旨在回顾分析 6 例齿状突骨患者轻微创伤后急性颈髓损伤。
回顾性分析 2012 年至 2013 年 6 例齿状突骨患者发生急性创伤性颈髓损伤的临床资料、神经症状、影像学检查、随访时间、美国脊柱损伤协会（ASIA）损伤分级和运动评分。
男 2 例，女 4 例，年龄 4 ～ 18 岁，平均 11.8 岁。创伤前，2 例无症状，4 例表现为脊髓病特征，行走不稳。跌倒最常见（n=5），其次是轻微机动车事故（n=1）。所有患者均行颈椎动力侧位片和磁共振成像检查，均表现为寰枢椎不稳和脊髓受压。大多数患者磁共振成像显示脊髓变薄，T2 加权序列呈高信号。脊髓压迫在前 2 例，前、后均在 4 例。入院时，2 例患者为 ASIA B 级，1 例为 ASIA C 级，3 例为 ASIA D 级。2 例患者术后围手术期因呼吸衰竭行机械通气 2 周以上。术后所有患者均行后路寰枢椎固定融合，神经功能和临床症状均改善。
无症状或脊髓型寰枢椎不稳的儿童患者，即使轻微创伤后也有发生急性脊髓损伤的风险。对于齿状突骨患者，应进行充分的固定融合，以预防进展性脊髓病，并改善急性创伤性颈髓损伤的神经症状。
