Management of an odontoid synchondrosis fracture causing chronic translational anterior atlanto-axial subluxation in a child with autism: case report

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The authors report an unusual case of an odontoid synchondrosis fracture causing chronic translational anterior atlanto-axial subluxation and present a discussion of the unique management of this case. Traumatic translational anterior atlanto-axial subluxation is a rare manifestation within pediatrics. Patients with preexisting abnormalities in ligamentous or bony structures may present with unusual symptomatology, which could result in delay of treatment. A 6-year-old male patient with autism who presented with acute respiratory arrest was noted to have an odontoid synchondrosis fracture and severe anterior translational atlanto-axial subluxation. Initial attempts at reduction with halo traction were tried for first-line treatment. However, because of concern regarding possible inadvertent worsening of the impingement, the presence of comorbid macrocephaly, and possible instability with only C1–2 fusion, a posterior C1 laminectomy was performed. Further release of the C1–2 complex and odontoid peg from extensive fibrous tissue allowed for complete reduction. Acute injuries of the C1–2 complex may not present as expected, and the presence of pain is not a reliable symptom. Halo traction is an appropriate initial treatment, but some patients may require surgical realignment and stabilization.

ABBREVIATIONS MEP = motor evoked potential; SSEP = somatosensory evoked potential; tAAS = translational atlanto-axial subluxation.
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Correspondence Eylem Ocal: Arkansas Children’s Hospital, Little Rock, AR. WHEN CITING Published online November 1, 2019; DOI: 10.3171/2019.8.PEDS18517.Disclosures Dr. McCarthy reports being a consultant for Medtronic.
  • 1

    Clasper JCPailthorpe CA: Delayed diagnosis of an odontoid process fracture in an infant. Injury 26:2812821995

  • 2

    Crandall KMPacheco-Jacome ESandberg DI: Delayed presentation and conservative management of an odontoid basilar synchondrosis fracture in a child. Case report. J Neurosurg Pediatr 1:4024052008

    • Search Google Scholar
    • Export Citation
  • 3

    Dickman CAMamourian ASonntag VKDrayer BP: Magnetic resonance imaging of the transverse atlantal ligament for the evaluation of atlantoaxial instability. J Neurosurg 75:2212271991

    • Search Google Scholar
    • Export Citation
  • 4

    Rusin JARuess LDaulton RS: New C2 synchondrosal fracture classification system. Pediatr Radiol 45:8728812015

  • 5

    Yang SYBoniello AJPoorman CEChang ALWang SPassias PG: A review of the diagnosis and treatment of atlantoaxial dislocations. Global Spine J 4:1972102014

    • Search Google Scholar
    • Export Citation


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