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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

Magnetic resonance imaging demonstrated overt intensity changes of C2, which was low intensity on both (a) T1- and (b) T2-weighted images but high intensity on STIR (c) images. Spinal cord involvement was not evident.
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fig2: Magnetic resonance imaging demonstrated overt intensity changes of C2, which was low intensity on both (a) T1- and (b) T2-weighted images but high intensity on STIR (c) images. Spinal cord involvement was not evident.

Mentions: She complained about persistent severe diffuse neck pain. Four days later, magnetic resonance (MR) imaging was performed to rule out latent fresh compression fracture and overt intensity changes of axis, which was low intensity on both T1- and T2-weighted images but high intensity on STIR image, were found (Figures 2(a)–2(c)). Subsequent computed tomography (CT) clearly demonstrated Anderson type III odontoid fracture (Figures 3(a) and 3(b)). Routine blood tests including serum Ca, P, and parathyroid hormone level were unremarkable.


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)

Magnetic resonance imaging demonstrated overt intensity changes of C2, which was low intensity on both (a) T1- and (b) T2-weighted images but high intensity on STIR (c) images. Spinal cord involvement was not evident.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig2: Magnetic resonance imaging demonstrated overt intensity changes of C2, which was low intensity on both (a) T1- and (b) T2-weighted images but high intensity on STIR (c) images. Spinal cord involvement was not evident.
Mentions: She complained about persistent severe diffuse neck pain. Four days later, magnetic resonance (MR) imaging was performed to rule out latent fresh compression fracture and overt intensity changes of axis, which was low intensity on both T1- and T2-weighted images but high intensity on STIR image, were found (Figures 2(a)–2(c)). Subsequent computed tomography (CT) clearly demonstrated Anderson type III odontoid fracture (Figures 3(a) and 3(b)). Routine blood tests including serum Ca, P, and parathyroid hormone level were unremarkable.

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