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Atraumatic Occult Odontoid Fracture in Patients with Osteoporosis-Associated Thoracic Kyphotic Deformity: Report of a Case and Review of the Literature.

Mori K, Nishizawa K, Nakamura A, Imai S - Case Rep Orthop (2015)

Bottom Line: Conservative treatment achieved complete bone union without neurological deteriorations.At 3-year follow-up, the patient was doing well without neurological and radiological deteriorations.Even if the patients have no traumatic event, we have to keep odontoid fractures in our mind as one of the differential diagnoses when we encounter elderly patients with neck pain, especially in patients with osteoporosis-associated marked thoracic kyphotic deformity.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan.

ABSTRACT
Anderson type II odontoid fractures are reported to be the most common injury of the odontoid process in patients over the age of 65. However, atraumatic occult Anderson type III odontoid fractures have been rarely described and remain a diagnostic challenge. In the present report, we illustrate a 78-year-old female with osteoporosis-associated marked thoracic kyphotic deformity who developed atraumatic Anderson type III occult odontoid fracture and raise awareness of this condition. Anteroposterior and lateral standard radiographs of cervical spine failed to disclose odontoid fracture. Magnetic resonance imaging demonstrated intensity changes of the axis. Subsequent computed tomography clearly demonstrated Anderson type III odontoid fracture. Conservative treatment achieved complete bone union without neurological deteriorations. At 3-year follow-up, the patient was doing well without neurological and radiological deteriorations. Even if the patients have no traumatic event, we have to keep odontoid fractures in our mind as one of the differential diagnoses when we encounter elderly patients with neck pain, especially in patients with osteoporosis-associated marked thoracic kyphotic deformity.

No MeSH data available.


Related in: MedlinePlus

Anteroposterior (a) and lateral (b) standard radiographs of cervical spine revealed degenerative spondylosis but failed to reveal apparent fracture in cervical spine. Lateral standard radiographs of thoracolumbar spine revealed marked thoracic kyphotic deformity due to multiple compression fractures (c).
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fig1: Anteroposterior (a) and lateral (b) standard radiographs of cervical spine revealed degenerative spondylosis but failed to reveal apparent fracture in cervical spine. Lateral standard radiographs of thoracolumbar spine revealed marked thoracic kyphotic deformity due to multiple compression fractures (c).

Mentions: A 78-year-old female experienced sudden severe neck pain when she looked up the refrigerator (her cervical spine was extended) to open its door and visited our institution. She had a mild occasional neck pain before this event; however she reported no traumatic event just before the onset of this symptom or in the past. Physical examination revealed the absence of neurological compromise. In turn, anteroposterior and lateral standard radiographs of cervical spine revealed cervical degenerative spondylosis, but we could not detect apparent fracture (Figures 1(a) and 1(b)). Lateral standard radiographs of thoracolumbar spine revealed marked thoracic kyphotic deformity due to multiple compression fractures (Figure 1(c)). It was difficult to find normal-shaped vertebrae in thoracic spine and thoracic kyphosis angle measured by T5-12 was 75 degrees (Figure 1(c)). Her bone mineral density (T-score: −3.5) was significantly low.


Atraumatic Occult Odontoid Fracture in Patients with Osteoporosis-Associated Thoracic Kyphotic Deformity: Report of a Case and Review of the Literature.

Mori K, Nishizawa K, Nakamura A, Imai S - Case Rep Orthop (2015)

Anteroposterior (a) and lateral (b) standard radiographs of cervical spine revealed degenerative spondylosis but failed to reveal apparent fracture in cervical spine. Lateral standard radiographs of thoracolumbar spine revealed marked thoracic kyphotic deformity due to multiple compression fractures (c).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4563060&req=5

fig1: Anteroposterior (a) and lateral (b) standard radiographs of cervical spine revealed degenerative spondylosis but failed to reveal apparent fracture in cervical spine. Lateral standard radiographs of thoracolumbar spine revealed marked thoracic kyphotic deformity due to multiple compression fractures (c).
Mentions: A 78-year-old female experienced sudden severe neck pain when she looked up the refrigerator (her cervical spine was extended) to open its door and visited our institution. She had a mild occasional neck pain before this event; however she reported no traumatic event just before the onset of this symptom or in the past. Physical examination revealed the absence of neurological compromise. In turn, anteroposterior and lateral standard radiographs of cervical spine revealed cervical degenerative spondylosis, but we could not detect apparent fracture (Figures 1(a) and 1(b)). Lateral standard radiographs of thoracolumbar spine revealed marked thoracic kyphotic deformity due to multiple compression fractures (Figure 1(c)). It was difficult to find normal-shaped vertebrae in thoracic spine and thoracic kyphosis angle measured by T5-12 was 75 degrees (Figure 1(c)). Her bone mineral density (T-score: −3.5) was significantly low.

Bottom Line: Conservative treatment achieved complete bone union without neurological deteriorations.At 3-year follow-up, the patient was doing well without neurological and radiological deteriorations.Even if the patients have no traumatic event, we have to keep odontoid fractures in our mind as one of the differential diagnoses when we encounter elderly patients with neck pain, especially in patients with osteoporosis-associated marked thoracic kyphotic deformity.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga 520-2192, Japan.

ABSTRACT
Anderson type II odontoid fractures are reported to be the most common injury of the odontoid process in patients over the age of 65. However, atraumatic occult Anderson type III odontoid fractures have been rarely described and remain a diagnostic challenge. In the present report, we illustrate a 78-year-old female with osteoporosis-associated marked thoracic kyphotic deformity who developed atraumatic Anderson type III occult odontoid fracture and raise awareness of this condition. Anteroposterior and lateral standard radiographs of cervical spine failed to disclose odontoid fracture. Magnetic resonance imaging demonstrated intensity changes of the axis. Subsequent computed tomography clearly demonstrated Anderson type III odontoid fracture. Conservative treatment achieved complete bone union without neurological deteriorations. At 3-year follow-up, the patient was doing well without neurological and radiological deteriorations. Even if the patients have no traumatic event, we have to keep odontoid fractures in our mind as one of the differential diagnoses when we encounter elderly patients with neck pain, especially in patients with osteoporosis-associated marked thoracic kyphotic deformity.

No MeSH data available.


Related in: MedlinePlus