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Occipital Condyle Fracture with Accompanying Meningeal Spinal Cysts as a result of Cervical Spine Injury in 15-Year-Old Girl.

Wiktor Ł, Tomaszewski R - Case Rep Orthop (2015)

Bottom Line: We established that clinical effect after completed treatment is very good.Due to clinically silent course of the disease, we decided to use the conservative treatment.The patient remains under control of our department.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Orthopaedics, Silesian Medical University, Katowice, Poland.

ABSTRACT
The occipital condyle fracture is rare injury of the craniocervical junction. Meningeal spinal cysts are rare tumors of the spinal cord. Depending on location, these lesions may be classified as extradural and subdural, but extradural spinal cysts are more common. We present the case of a 15-year-old girl who suffered from avulsion occipital condyle fracture treated with use of "halo-vest" system. We established that clinical effect after completed treatment is very good. Control MRI evaluation was performed 12 months after removal of "halo-vest" traction, and clinically silent extradural meningeal spinal cysts were detected at the ventral side of the spinal cord in the cervical segment of the spine. Due to clinically silent course of the disease, we decided to use the conservative treatment. The patient remains under control of our department.

No MeSH data available.


Related in: MedlinePlus

Three-dimensional CT reconstruction image shows avulsion fracture of the right occipital condyle (back view).
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Related In: Results  -  Collection


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fig2: Three-dimensional CT reconstruction image shows avulsion fracture of the right occipital condyle (back view).

Mentions: A 15-year-old girl experienced injury of the head and the cervical segment of the spine as a result of being hit by a car. Indirect injury of the craniocervical junction resulted from the fall in bend-rotation mechanism. The patient was initially managed at the site of incident by the emergency medical service, and she was transported to the emergency department. At the moment of admission, the patient was conscious and confused and with GCS score of 13 points. Based on conducted imaging diagnostics (trauma scan CT before and after intravenous administration of the contrast medium), the following diagnosis was established: multifocal injury, pulmonary contusion with laceration, and the right occipital condyle fracture (Figures 1 and 2). General condition of the patient was stable, and decision was made to transfer the patient to the Center of Pediatric Traumatology. The diagnostics in our department was extended with MRI of the head and MRI of the cervical segment of the spine in order to evaluate the ligament system of C0-C1-C2 junction (Figure 3) and control evaluation with CT-scan of the head. Based on aforementioned evaluations, the following diagnosis was established: avulsion fracture of the right occipital condyle (type III according to Anderson-Montesano classification). Considering unstable nature of the fracture, the patient was qualified for treatment with use of an external fixation of “halo-vest” type. Paraprocedural and postprocedural course were not complicated. “Halo-vest” fixation was maintained over 13 weeks with performed control of local condition of the skin within the area of the pins and neurological condition of the patient focused on the inferior cranial nerves IX–XII. Within the 5th week of treatment, control X-ray of the cervical segment of the spine and MRI evaluation were performed, based on which maintained asymmetry was diagnosed in the medial atlantoaxial joint and signs of progressing adhesion at the level of the right alar ligament. In the vertebral canal at the level of C2-C3 at the front of the spinal cord, in extradural location, mainly at the left side, narrow fluid compartment was visualized (Figure 4). Treatment was not complicated. “Halo-vest” system was removed. X-ray of the cervical spine (AP + LATERAL + AP open mouth view, Figure 5) was performed as well as functional X-ray in anteflexion and retroflexion based on which no signs of instability were established at the level of C0-C1-C2. The patient received an additional treatment with the cervical collar over 4 weeks. After 20 weeks following injury, clinical evaluation was performed; the patient did not report any pain within the cervical spine. NDI (Neck Disability Index) was established with exclusion of point 8 (car driving) obtaining the result of 3/45 (6.7%) which allowed ruling out disability caused by pain of the cervical segment of the spine. 12 months after removal of “halo-vest” system, control MRI evaluation of the craniocervical junction revealed significant enlargement of previously described fluid cistern. Extradural meningeal spinal cyst was diagnosed, which was located between the levels of C2 and C7, measuring up to 6 mm thick in the largest dimension (Figure 6). Due to lack of clinical manifestation, the patient was qualified for conservative treatment under control of the orthopedist and the neurosurgeon.


Occipital Condyle Fracture with Accompanying Meningeal Spinal Cysts as a result of Cervical Spine Injury in 15-Year-Old Girl.

Wiktor Ł, Tomaszewski R - Case Rep Orthop (2015)

Three-dimensional CT reconstruction image shows avulsion fracture of the right occipital condyle (back view).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4620383&req=5

fig2: Three-dimensional CT reconstruction image shows avulsion fracture of the right occipital condyle (back view).
Mentions: A 15-year-old girl experienced injury of the head and the cervical segment of the spine as a result of being hit by a car. Indirect injury of the craniocervical junction resulted from the fall in bend-rotation mechanism. The patient was initially managed at the site of incident by the emergency medical service, and she was transported to the emergency department. At the moment of admission, the patient was conscious and confused and with GCS score of 13 points. Based on conducted imaging diagnostics (trauma scan CT before and after intravenous administration of the contrast medium), the following diagnosis was established: multifocal injury, pulmonary contusion with laceration, and the right occipital condyle fracture (Figures 1 and 2). General condition of the patient was stable, and decision was made to transfer the patient to the Center of Pediatric Traumatology. The diagnostics in our department was extended with MRI of the head and MRI of the cervical segment of the spine in order to evaluate the ligament system of C0-C1-C2 junction (Figure 3) and control evaluation with CT-scan of the head. Based on aforementioned evaluations, the following diagnosis was established: avulsion fracture of the right occipital condyle (type III according to Anderson-Montesano classification). Considering unstable nature of the fracture, the patient was qualified for treatment with use of an external fixation of “halo-vest” type. Paraprocedural and postprocedural course were not complicated. “Halo-vest” fixation was maintained over 13 weeks with performed control of local condition of the skin within the area of the pins and neurological condition of the patient focused on the inferior cranial nerves IX–XII. Within the 5th week of treatment, control X-ray of the cervical segment of the spine and MRI evaluation were performed, based on which maintained asymmetry was diagnosed in the medial atlantoaxial joint and signs of progressing adhesion at the level of the right alar ligament. In the vertebral canal at the level of C2-C3 at the front of the spinal cord, in extradural location, mainly at the left side, narrow fluid compartment was visualized (Figure 4). Treatment was not complicated. “Halo-vest” system was removed. X-ray of the cervical spine (AP + LATERAL + AP open mouth view, Figure 5) was performed as well as functional X-ray in anteflexion and retroflexion based on which no signs of instability were established at the level of C0-C1-C2. The patient received an additional treatment with the cervical collar over 4 weeks. After 20 weeks following injury, clinical evaluation was performed; the patient did not report any pain within the cervical spine. NDI (Neck Disability Index) was established with exclusion of point 8 (car driving) obtaining the result of 3/45 (6.7%) which allowed ruling out disability caused by pain of the cervical segment of the spine. 12 months after removal of “halo-vest” system, control MRI evaluation of the craniocervical junction revealed significant enlargement of previously described fluid cistern. Extradural meningeal spinal cyst was diagnosed, which was located between the levels of C2 and C7, measuring up to 6 mm thick in the largest dimension (Figure 6). Due to lack of clinical manifestation, the patient was qualified for conservative treatment under control of the orthopedist and the neurosurgeon.

Bottom Line: We established that clinical effect after completed treatment is very good.Due to clinically silent course of the disease, we decided to use the conservative treatment.The patient remains under control of our department.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Orthopaedics, Silesian Medical University, Katowice, Poland.

ABSTRACT
The occipital condyle fracture is rare injury of the craniocervical junction. Meningeal spinal cysts are rare tumors of the spinal cord. Depending on location, these lesions may be classified as extradural and subdural, but extradural spinal cysts are more common. We present the case of a 15-year-old girl who suffered from avulsion occipital condyle fracture treated with use of "halo-vest" system. We established that clinical effect after completed treatment is very good. Control MRI evaluation was performed 12 months after removal of "halo-vest" traction, and clinically silent extradural meningeal spinal cysts were detected at the ventral side of the spinal cord in the cervical segment of the spine. Due to clinically silent course of the disease, we decided to use the conservative treatment. The patient remains under control of our department.

No MeSH data available.


Related in: MedlinePlus