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Atlantoaxial Instability of the Atlas Posterior Arch Associated with Ossiculum Odontoideum in a High School Gymnast

LaKiesha N. Bohannon, Michael Lozano, Lori Greenwood

Abstract


Theobjective of the study was to examine a case report of a 17 year old femalegymnast who presented with quadriplegia after landing on her neck in the flexedposition while performing a backhand spring. She was suspected to have:cervical/odontoid fracture, cervical dislocation, multidirectional instabilityof C1 on C2, spinal cord impingement, persistentossiculum terminale, odontoid hypoplasia or a combination of the previouslylisted conditions. Imaging via X-Rays and CT scans identified an ossiculumodontoideum. It was later determined that a closed dislocation of C1 andlesions of C1-C4 of the spinal cord accompanied the ossiculum odontoideum. The gymnastunderwent trans articular screw fixation surgery and was able to make a fullrecovery, but unable to return to gymnastics or any contact sports.Cases such as this one are often seen early in infants or in individuals withDown’s syndrome, mucopolysaccharidosis, Morquio’s syndrome or connectivetissue/skeletal development disorders. It is also uncommon to have a conditionthis severe that does not present symptoms prior to an injury. Approximately 90% of patients with this condition haveimprovement or resolution of presenting symptoms once undergoing surgicalintervention. The physician’s recommendation to treat the condition surgicallywas based on the patient’s age and activity level.Key Words: ossiculum odontoideum, atlantoaxial instability,trans articular screw fixation

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