Os Odontoideum - Meaning and Interpretation in Connection with a Traumatic Incident

Abstract

Traumatic spinal injuries in children are rare, on the other hand fractures in the dens area are only portrayed in the literature in very few cases. In this study we report the patient history, diagnosis and treatment of two patients, a 9-year-old boy and a 10.5-year-old girl. Both showed an acquired os odontoideum, displayed clear neurological symptoms and were surgically stabilised from the dorsal side. In both cases no previous history of traumatic injury could be ascertained. At 18 and 22 months post-operatively, respectively, the iliac crest bone graft and the wire loops were in the correct position. The patients were pain free. When assessing a child with vertebral trauma (os odontoideum), a detailed history and radiological investigations are essential to elicit pre-existing neck symptoms and exclude previous trauma.

Key words

Os odontoideum - infant spine - infant vertebra - atlanto-axial instability

References

• 1 Alp M S, Crockard H A. Late complication of undetected odontoid fracture in children.  Br Med J. 1990;  300 319-320
• 2 Anderson J M, Schutt A H. Spinal injury in children: A review of 156 cases seen from 1950 through 1978.  Mayo Clin Proc. 1980;  55 499-504
• 3 Blauth M, Schmidt U, Lange U. Verletzungen der Halswirbelsäule bei Kindern.  Unfallchirurgie. 1998;  101 590-612
• 4 Dyck P. Os odontoideum in children: neurological manifestations and surgical management.  Neurosurgery. 1978;  2 93-99
• 5 Edmunds I A, Cummine J L. Spontaneous bone graft resorption in os odentoideum.  Aust N Z J Surg. 1992;  62 502-505
• 6 Fielding J W. Disappearance of the central portion of the odontoid process.  J Bone Joint Surg [Am]. 1965;  47 1228-1230
• 7 Fielding J W, Griffin P P. Os odontoideum - An acquired lesion.  J Bone Joint Surg [Am]. 1974;  56 187-190
• 8 Fielding J W, Hensinger R N, Hawkins R J. Os odontoideum.  J Bone Joint Surg [Am]. 1980;  62 376-383
• 9 Freiberger R H, Wilson P D, Nicholas J A. Acquired absence of the odontoid process.  J Bone Joint Surg [Am]. 1965;  47 1231-1236
• 10 Fujii E, Kobayashi K, Hiabayashi K. Treatment in fractures of the odontoid process.  Spine. 1988;  13 604-609
• 11 Hawkins R J, Fielding J W, Thompson W J. Os odontoideum - Congential or acquired.  J Bone Joint Surg [Am]. 1976;  58 413-414
• 12 Holmes J C, Hall J E. Fusion for instability and potential instability of the cervical spine in children and adolescents.  Orthop Clin North Am. 1978;  9 923-943
• 13 Koop S E, Winter R B, Lonstein J E. The surgical treatment of instability of the upper part of the cervical spine in children and adolescents.  J Bone Joint Surg [Am]. 1984;  66 403-411
• 14 McWorther J M, Alexander Jr  E, Davis Jr  C H, Kelly Jr  D L. Posterior cervical fusion in children.  J Neurosurg. 1976;  45 211-215
• 15 Ogden J A. Skeletal injury in the child. Saunders, Philadelphia 1988
• 16 Ricciardi J E, Kaufer H, Louis D S. Acquired os odontoideum following acute ligament injury.  J Bone Joint Surg [Am]. 1976;  58 410-412
• 17 Schuler T C, Kurz L, Thompson E, Zemenick G, Hensinger R N, Herkowitz H N. Natural history of Os odontoideum.  J Pediatr Orthop. 1991;  11 222-225
• 18 Schwarz N, Ohner T, Schwarz A F, Gerschpacher M, Meznik A. Verletzungen der Halswirbelsäule bei Kindern und Jugendlichen.  Unfallchirurg. 1993;  96 235-241
• 19 Seimon L P. Fracture of the odontoid process in young children.  J Bone Joint Surg [Am]. 1977;  59 943-948
• 20 Sherk H H, Nicholson J T, Chung S MK. Fracture of the odontoid process in young children.  J Bone Joint Surg [Am]. 1978;  60 921-924
• 21 Smith M D, Phillips W A, Hensinger R N. Fusion of the upper cervical spine in 2 children and adolescents.  Spine. 1991;  16 695-701
• 22 Swischuk L E. Anterior displacement of C 2 in children: physiologic or pathologic?.  Pediatr Radiol. 1977;  122 759-763
• 23 Torklus D v, Gehle W. Die obere Halswirbelsäule. Thieme, Stuttgart, New York 1987