Intraspinal osteochondroma causing neurological manifestations is a rare condition and can present as either solitary osteochondroma or more commonly as a part of multiple hereditary exostoses. We report a case of osteochondroma arising from lamina of C2 in a 21-year-old patient with multiple hereditary exostoses causing spinal cord compression and cervical myelopathy. The patient presented with worsening neurological deficit and an inability to walk. Immediate laminectomy and surgical decompression were done after accurately localizing the lesion through computed tomography and magnetic resonance images. Following excision of the lesion, the patient recovered completely. The case report is followed by a review of literature highlighting the incidence of spinal osteochondroma, location preferences, clinical presentation, diagnosis, and results of decompression.
{"title":"C2 intraspinal osteochondroma causing spinal cord compression in a patient with multiple hereditary exostoses","authors":"J. Aithala","doi":"10.4103/isj.isj_55_20","DOIUrl":"https://doi.org/10.4103/isj.isj_55_20","url":null,"abstract":"Intraspinal osteochondroma causing neurological manifestations is a rare condition and can present as either solitary osteochondroma or more commonly as a part of multiple hereditary exostoses. We report a case of osteochondroma arising from lamina of C2 in a 21-year-old patient with multiple hereditary exostoses causing spinal cord compression and cervical myelopathy. The patient presented with worsening neurological deficit and an inability to walk. Immediate laminectomy and surgical decompression were done after accurately localizing the lesion through computed tomography and magnetic resonance images. Following excision of the lesion, the patient recovered completely. The case report is followed by a review of literature highlighting the incidence of spinal osteochondroma, location preferences, clinical presentation, diagnosis, and results of decompression.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"137 - 141"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48666283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sensorineural hearing loss (SNHL) is a known but rare complication of non-otological surgeries. SNHL after spinal decompression also remains a rare occurrence with a handful of reports in the literature. The exact mechanism is not clearly understood. Cerebrospinal fluid leak, barotrauma, microemboli, hypoperfusion, vasospasm, traumatic event, and anesthetic agents are some of the proposed etiologies. Early diagnosis and prompt intervention have shown benefits though management lacks consensus. We report a case of profound SNHL post-lumbar decompression and fixation surgery, who showed significant recovery at 4-week follow-up, and we review the literature for hearing loss after spine surgeries.
{"title":"Rare sudden hearing loss after lumbar spine decompression surgery: A case report and review of the literature","authors":"S. Acharya, V. Khanna, N. Adsul, R. Chahal","doi":"10.4103/isj.isj_36_21","DOIUrl":"https://doi.org/10.4103/isj.isj_36_21","url":null,"abstract":"Sensorineural hearing loss (SNHL) is a known but rare complication of non-otological surgeries. SNHL after spinal decompression also remains a rare occurrence with a handful of reports in the literature. The exact mechanism is not clearly understood. Cerebrospinal fluid leak, barotrauma, microemboli, hypoperfusion, vasospasm, traumatic event, and anesthetic agents are some of the proposed etiologies. Early diagnosis and prompt intervention have shown benefits though management lacks consensus. We report a case of profound SNHL post-lumbar decompression and fixation surgery, who showed significant recovery at 4-week follow-up, and we review the literature for hearing loss after spine surgeries.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"129 - 132"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48658929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a patient with cauda equina syndrome who presented immediately following hysterectomy. Intraoperative cauda equina syndrome is very rare, and to our knowledge, this is the first case reported following a gynecological procedure, which was unequivocally caused by a herniated intervertebral disc. A 72-year-old woman with a history of chronic low back pain and degenerative disc disease was referred to the orthopedic service after developing urinary retention, decreased rectal tone, and diminished bilateral lower extremity sensory and motor function following hysterectomy for the management of endometrial carcinoma. Magnetic resonance imaging revealed a large central disc herniation at L2/3. Due to a delay in recognition of the progressive neurological deterioration that began immediately postoperatively, decompressive surgery was performed between 48 and 72 hours after the onset of symptoms. Emergent surgical decompression including laminectomy and microdiscectomy resulted in improved bowel and urinary function but no improvement in lower extremity strength or sensation. Cauda equina syndrome is a rare but devastating condition whose recognition and management requires vigilance, communication, and early surgical involvement. This case presents novel information that cauda equina syndrome can occur immediately postoperatively from disc prolapse during unrelated procedures.
{"title":"Acute postoperative cauda equina syndrome following an elective gynecological procedure","authors":"Conor B Garry, Woojin Cho, Alan Job, A. Sharan","doi":"10.4103/isj.isj_94_20","DOIUrl":"https://doi.org/10.4103/isj.isj_94_20","url":null,"abstract":"We report a patient with cauda equina syndrome who presented immediately following hysterectomy. Intraoperative cauda equina syndrome is very rare, and to our knowledge, this is the first case reported following a gynecological procedure, which was unequivocally caused by a herniated intervertebral disc. A 72-year-old woman with a history of chronic low back pain and degenerative disc disease was referred to the orthopedic service after developing urinary retention, decreased rectal tone, and diminished bilateral lower extremity sensory and motor function following hysterectomy for the management of endometrial carcinoma. Magnetic resonance imaging revealed a large central disc herniation at L2/3. Due to a delay in recognition of the progressive neurological deterioration that began immediately postoperatively, decompressive surgery was performed between 48 and 72 hours after the onset of symptoms. Emergent surgical decompression including laminectomy and microdiscectomy resulted in improved bowel and urinary function but no improvement in lower extremity strength or sensation. Cauda equina syndrome is a rare but devastating condition whose recognition and management requires vigilance, communication, and early surgical involvement. This case presents novel information that cauda equina syndrome can occur immediately postoperatively from disc prolapse during unrelated procedures.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"125 - 128"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42253174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Epidermoid cysts of the presacral space are a rare congenital entity. They have mostly been reported among women. We report a case of a 28-year-old male presenting with chronic constipation wherein magnetic resonance imaging (MRI) was suggestive of an anterior sacral meningocele associated with an epidermoid. This patient underwent a laparotomy and total excision of the mass. The lesion turned out to be an epidermoid cyst without any intradural communication or associated meningocele. This report highlights the limitations of imaging while it accentuates the need to perform diffusion-weighted MRI sequences for all cystic tumors in this region and to choose the correct operative approach based on its exact location in the presacral space.
{"title":"Presacral epidermoid: A rare case and meningocele mimick","authors":"S. Mediratta","doi":"10.4103/isj.isj_76_20","DOIUrl":"https://doi.org/10.4103/isj.isj_76_20","url":null,"abstract":"Epidermoid cysts of the presacral space are a rare congenital entity. They have mostly been reported among women. We report a case of a 28-year-old male presenting with chronic constipation wherein magnetic resonance imaging (MRI) was suggestive of an anterior sacral meningocele associated with an epidermoid. This patient underwent a laparotomy and total excision of the mass. The lesion turned out to be an epidermoid cyst without any intradural communication or associated meningocele. This report highlights the limitations of imaging while it accentuates the need to perform diffusion-weighted MRI sequences for all cystic tumors in this region and to choose the correct operative approach based on its exact location in the presacral space.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"120 - 124"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45033972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Chhabra, N. Jagadeesh, Kuldeep Bansal, P. Yelamarthy
This is a narrative review to get an overview of the diagnosis and management of the acute traumatic cervical central cord syndrome (ATCCS) with an evidence-based approach. We considered articles that addressed the gray areas in the management of ATCCS, that is, the need for surgical intervention and its timing. The ATCCS is the most common form of incomplete spinal cord injury. The presence of instability and deteriorating neurology have been absolute indications for surgery. The opinion has been divided between early surgeries vis-à-vis monitoring for recovery and delayed surgery if neurological recovery plateaus. An extensive search revealed a low level of evidence. With the advent of modern anesthetic as well as surgical techniques and perioperative management, there may be better and faster neurological recovery with surgery. Considering the timing of surgery, even though many articles are propagating the need for early surgery the level of evidence remains low. This narrative review highlights the need for well-conducted prospective studies to resolve the controversy regarding early surgery versus conservative management and delayed surgery if recovery plateaus or on neurological deterioration. Since there is only a low level of evidence in favor of early surgery for ATCCS with no instability and deteriorating neurology, the decision of the surgery and its timing should be left to the surgeon’s judgment, with a plan tailored after assessing risks and benefits.
{"title":"Diagnosis and management of acute traumatic central cord syndrome: Present consensus and narrative review","authors":"H. Chhabra, N. Jagadeesh, Kuldeep Bansal, P. Yelamarthy","doi":"10.4103/isj.isj_40_21","DOIUrl":"https://doi.org/10.4103/isj.isj_40_21","url":null,"abstract":"This is a narrative review to get an overview of the diagnosis and management of the acute traumatic cervical central cord syndrome (ATCCS) with an evidence-based approach. We considered articles that addressed the gray areas in the management of ATCCS, that is, the need for surgical intervention and its timing. The ATCCS is the most common form of incomplete spinal cord injury. The presence of instability and deteriorating neurology have been absolute indications for surgery. The opinion has been divided between early surgeries vis-à-vis monitoring for recovery and delayed surgery if neurological recovery plateaus. An extensive search revealed a low level of evidence. With the advent of modern anesthetic as well as surgical techniques and perioperative management, there may be better and faster neurological recovery with surgery. Considering the timing of surgery, even though many articles are propagating the need for early surgery the level of evidence remains low. This narrative review highlights the need for well-conducted prospective studies to resolve the controversy regarding early surgery versus conservative management and delayed surgery if recovery plateaus or on neurological deterioration. Since there is only a low level of evidence in favor of early surgery for ATCCS with no instability and deteriorating neurology, the decision of the surgery and its timing should be left to the surgeon’s judgment, with a plan tailored after assessing risks and benefits.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"39 - 46"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41703992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Traumatic spinal cord injuries (SCIs) have devastating physical, social, and financial consequences for both patients and their families. SCIs most frequently occur at the cervical spine level, and these injuries are particularly prone to causing debilitating functional impairments. Unfortunately, no effective neuroregenerative therapeutic approaches capable of reversing lost neurologic and functional impairments exist, resulting in a large number of patients living with the persistent disability caused by a chronic cervical SCI. Over the past decades, a multitude of nonpharmacologic and pharmacologic neuroprotective strategies have been intensely investigated, including the timing of surgical decompression and the role of methylprednisolone sodium succinate (MPSS) in patients with acute SCI. These strategies have been the source of vibrant debate surrounding their potential risks and benefits. Our aim in this combined narrative and updated systematic review is to provide an assessment on the timing of surgical decompression as well as the role of high-dose MPSS treatment in patients with traumatic SCIs, with a special emphasis on the cervically injured subpopulation. Based on the current literature, there is strong evidence to support early surgical decompression within 24 h of injury to promote enhanced neurologic recovery. Meanwhile, moderate evidence supports the early initiation of a 24-h high-dose MPSS treatment within 8 h of injury, particularly in patients with a cervical SCI.
{"title":"Controversies in cervical spine trauma: The role of timing of surgical decompression and the use of methylprednisolone sodium succinate in spinal cord injury. A narrative and updated systematic review","authors":"Nader Hejrati, B. Rocos, M. Fehlings","doi":"10.4103/isj.isj_26_21","DOIUrl":"https://doi.org/10.4103/isj.isj_26_21","url":null,"abstract":"Traumatic spinal cord injuries (SCIs) have devastating physical, social, and financial consequences for both patients and their families. SCIs most frequently occur at the cervical spine level, and these injuries are particularly prone to causing debilitating functional impairments. Unfortunately, no effective neuroregenerative therapeutic approaches capable of reversing lost neurologic and functional impairments exist, resulting in a large number of patients living with the persistent disability caused by a chronic cervical SCI. Over the past decades, a multitude of nonpharmacologic and pharmacologic neuroprotective strategies have been intensely investigated, including the timing of surgical decompression and the role of methylprednisolone sodium succinate (MPSS) in patients with acute SCI. These strategies have been the source of vibrant debate surrounding their potential risks and benefits. Our aim in this combined narrative and updated systematic review is to provide an assessment on the timing of surgical decompression as well as the role of high-dose MPSS treatment in patients with traumatic SCIs, with a special emphasis on the cervically injured subpopulation. Based on the current literature, there is strong evidence to support early surgical decompression within 24 h of injury to promote enhanced neurologic recovery. Meanwhile, moderate evidence supports the early initiation of a 24-h high-dose MPSS treatment within 8 h of injury, particularly in patients with a cervical SCI.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"47 - 68"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41510531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Outcome prediction is fundamental for patients with spinal cord injury (SCI) to allow correct counselling of patients and their families and to determine resource allocation during and after rehabilitation immediately after the lesion. Furthermore, knowledge of the natural history of SCI is mandatory to project and assess the results of clinical trials.Thus, the aim of this narrative review was to provide a clear picture of the neurological and functional outcomes of subjects with cervical SCI.This review was based on MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Central Register of Controlled Trials databases. The following search terms were used: prognosis prediction, SCI, tetraplegia/quadriplegia, neurologic recovery, and ambulation/gait/walking recovery. All article types of the manuscript were included with the exception of animal studies and studies in languages other than English.Both neurological and functional recovery could be prognosticated by the severity of the lesion as assessed by radiological findings and the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). The effect of other factors (such as age, gender and presence of specific syndromes) is also discussed in relation to neurologic and walking recovery.
结果预测是脊髓损伤（SCI）患者的基础，可以为患者及其家人提供正确的咨询，并在损伤后立即确定康复期间和康复后的资源分配。此外，了解SCI的自然史是预测和评估临床试验结果的必要条件。因此，这篇叙述性综述的目的是提供宫颈SCI受试者神经和功能结果的清晰图像。这篇综述基于MEDLINE、EMBASE、SCOPUS、Web of Science和Cochrane对照试验中央登记数据库。使用以下搜索术语：预后预测、SCI、四肢瘫痪/四肢瘫痪、神经系统恢复和行走/步态/步行恢复。除了动物研究和英语以外的语言研究外，手稿的所有文章类型都包括在内。根据放射学结果和国际脊髓损伤神经分类标准（ISNCSCI）评估的损伤严重程度，可以预测神经和功能恢复。还讨论了其他因素（如年龄、性别和特定综合征的存在）对神经系统和行走恢复的影响。
{"title":"Predicting outcomes following cervical spine trauma","authors":"G. Scivoletto","doi":"10.4103/isj.isj_29_21","DOIUrl":"https://doi.org/10.4103/isj.isj_29_21","url":null,"abstract":"Outcome prediction is fundamental for patients with spinal cord injury (SCI) to allow correct counselling of patients and their families and to determine resource allocation during and after rehabilitation immediately after the lesion. Furthermore, knowledge of the natural history of SCI is mandatory to project and assess the results of clinical trials.Thus, the aim of this narrative review was to provide a clear picture of the neurological and functional outcomes of subjects with cervical SCI.This review was based on MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Central Register of Controlled Trials databases. The following search terms were used: prognosis prediction, SCI, tetraplegia/quadriplegia, neurologic recovery, and ambulation/gait/walking recovery. All article types of the manuscript were included with the exception of animal studies and studies in languages other than English.Both neurological and functional recovery could be prognosticated by the severity of the lesion as assessed by radiological findings and the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). The effect of other factors (such as age, gender and presence of specific syndromes) is also discussed in relation to neurologic and walking recovery.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"5 1","pages":"69 - 81"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48521691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To study the clinicoradiological characteristics and surgical outcomes in patients with aggressive aneurysmal bone cyst (ABC) of spine. Materials and Methods: In this retrospective study, data was collected from patients with aggressive ABC of spine managed between January 2007 and December 2016. Clinical findings, radiological, and histological characteristics were studied. Follow-up was done either in the outpatient clinic or through a telephonic interview. Results: Seven patients (mean age, 15.6 years, range, 6–23 years) diagnosed with Enneking stage III aneurysmal bone cyst of the spine were included in the study. Local pain with restriction of movement was the most common presenting complaint (100%). Four patients presented with myelopathy. Thoracic spine was the most common site of involvement (43%). Of the patients, 71% had involvement of all three columns. All patients underwent surgical management; gross total resection in four patients (57%) and subtotal in three patients (43%). Of the seven patients, six required instrumented fusion. None of the patients developed any perioperative complication except for one patient who developed transient hip flexion worsening. Two patients received conformal radiation therapy (RT) postoperatively. The follow-up ranged from 40 months to 108 months (mean follow-up was 4.5 years). There were no recurrences. At last follow-up, all patients were alive and had significant improvement. Conclusions: ABC of the spine is found predominantly in the pediatric population. Intralesional en bloc resection with instrumented stabilization provides effective and fast relief from pain, early mobility, good surgical, and long-term outcomes. Conformal RT following a planned subtotal excision prevents the progression of the disease.
{"title":"Clinical and surgical outcomes of enneking stage III aneurysmal bone cysts of the spine","authors":"Sanjeev Pandey, E. Gandham, Krishna Prabhu","doi":"10.4103/isj.isj_29_20","DOIUrl":"https://doi.org/10.4103/isj.isj_29_20","url":null,"abstract":"Objective: To study the clinicoradiological characteristics and surgical outcomes in patients with aggressive aneurysmal bone cyst (ABC) of spine. Materials and Methods: In this retrospective study, data was collected from patients with aggressive ABC of spine managed between January 2007 and December 2016. Clinical findings, radiological, and histological characteristics were studied. Follow-up was done either in the outpatient clinic or through a telephonic interview. Results: Seven patients (mean age, 15.6 years, range, 6–23 years) diagnosed with Enneking stage III aneurysmal bone cyst of the spine were included in the study. Local pain with restriction of movement was the most common presenting complaint (100%). Four patients presented with myelopathy. Thoracic spine was the most common site of involvement (43%). Of the patients, 71% had involvement of all three columns. All patients underwent surgical management; gross total resection in four patients (57%) and subtotal in three patients (43%). Of the seven patients, six required instrumented fusion. None of the patients developed any perioperative complication except for one patient who developed transient hip flexion worsening. Two patients received conformal radiation therapy (RT) postoperatively. The follow-up ranged from 40 months to 108 months (mean follow-up was 4.5 years). There were no recurrences. At last follow-up, all patients were alive and had significant improvement. Conclusions: ABC of the spine is found predominantly in the pediatric population. Intralesional en bloc resection with instrumented stabilization provides effective and fast relief from pain, early mobility, good surgical, and long-term outcomes. Conformal RT following a planned subtotal excision prevents the progression of the disease.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"4 1","pages":"155 - 162"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49055251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The upper cervical spine remains the most susceptible region for spinal trauma in children, with odontoid fractures being the most common ones in this age group. Concomitant traumatic brain injuries or skull fractures can pose therapeutic challenges in such cases. We report a case of an 11-year-old boy who presented in the semiconscious state with a deep scalp laceration in the left frontoparietal region. A computed tomography (CT) scan revealed a depressed skull fracture requiring an emergency left frontoparietal decompressive craniectomy and an associated fracture of the odontoid process at the base with anterior displacement. Odontoid fractures usually heal well after immobilization, and the use of instrumented fusion is still debated in view of skeletal immaturity. The usual management of Halo vest could not be instituted in his case owing to the skull fracture, and a single cannulated screw fixation was done under fluoroscopic guidance. Direct operative fusion of the odontoid process has been described in younger children with apophyseal fractures, but the evidence of such procedures is rare in elder children with a fused odontoid process. This case report, thus, confirms the anterior odontoid screw fixation as an effective mode of treatment in children of the 7- to 12-year age group.
{"title":"Direct Anterior Screw Fixation for a Pediatric Odontoid Fracture with Associated Skull Fracture: A Case Report","authors":"D. Dutta, Arjun Dasgupta","doi":"10.4103/ISJ.ISJ_62_20","DOIUrl":"https://doi.org/10.4103/ISJ.ISJ_62_20","url":null,"abstract":"The upper cervical spine remains the most susceptible region for spinal trauma in children, with odontoid fractures being the most common ones in this age group. Concomitant traumatic brain injuries or skull fractures can pose therapeutic challenges in such cases. We report a case of an 11-year-old boy who presented in the semiconscious state with a deep scalp laceration in the left frontoparietal region. A computed tomography (CT) scan revealed a depressed skull fracture requiring an emergency left frontoparietal decompressive craniectomy and an associated fracture of the odontoid process at the base with anterior displacement. Odontoid fractures usually heal well after immobilization, and the use of instrumented fusion is still debated in view of skeletal immaturity. The usual management of Halo vest could not be instituted in his case owing to the skull fracture, and a single cannulated screw fixation was done under fluoroscopic guidance. Direct operative fusion of the odontoid process has been described in younger children with apophyseal fractures, but the evidence of such procedures is rare in elder children with a fused odontoid process. This case report, thus, confirms the anterior odontoid screw fixation as an effective mode of treatment in children of the 7- to 12-year age group.","PeriodicalId":34652,"journal":{"name":"Indian Spine Journal","volume":"4 1","pages":"234 - 239"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44551155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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