Occipitocervical fusion for reduction of traumatic periodontoid hypertrophic cicatrix

Case report

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✓ Periodontoid hypertrophic cicatrix resulting from trauma, as demonstrated by magnetic resonance (MR) imaging, is essentially the same as that seen in rheumatoid arthritis. Recent reports suggest that, in rheumatoid arthritis, occipitocervical fusion without transoral decompression of the pannus is adequate for resolution of this anterior lesion. A case of traumatic periodontoid cicatrix is presented in which posterior fusion resulted in reduction of the anterior mass lesion, clearly demonstrated by MR imaging. The etiology of periodontoid hypertrophic scarring, both traumatic and rheumatoid, is discussed in light of MR findings, and treatment implications are considered.

Article Information

Address reprint requests to: Thomas A. Lansen, M.D., Department of Neurosurgery, New York Medical College, Munger Pavilion, Room 329, Valhalla, New York 10595.

© AANS, except where prohibited by US copyright law.

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Figures

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    Sagittal magnetic resonance image (TE 20 msec, TR 500 msec) showing periodontoid pannus with intermediate signal intensity secondary to inflammatory and mechanical instability of rheumatoid arthritis.

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    Left: Sagittal T1-weighted magnetic resonance (MR) image showing traumatic periodontoid hypertrophic cicatrix with intermediate signal intensity. Note the similarity to the rheumatoid arthritis pannus shown in Fig. 1. Right: Axial MR image (TE 20 msec, TR 1000 msec) demonstrating compression of the neuraxis by traumatic scar tissue at C-2.

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    Sagittal magnetic resonance images (TE 20 msec, TR 500 msec) obtained 2 weeks after transoral surgery and posterior fusion. Partial decompression of the periodontoid cicatrix and resultant partial widening of the spinal cord are shown.

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    Magnetic resonance (MR) images obtained 9 months postoperatively. Left: Sagittal MR image (TE 20 msec, TR 500 msec) showing resolution of the periodontoid cicatrix, with expansion and normal configuration of the spinal cord. Right: Axial MR image (TE 20 msec, TR 1000 msec) of the C-2 area showing resolution of the periodontoid hypertrophic cicatrix and decompression of the spinal cord, with copious perimedullary subarachnoid space.

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