PubMed · 11083960
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Bravo Mata M, Pérez Muñuzuri A, Martinón Torres F, Monasterios Corral L, Alonso Martín A. 2000. [Persistent torticollis].. https://pubmed.ncbi.nlm.nih.gov/11083960/
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STUDY DESIGN: A case of combined odontoid and Jefferson fracture is reported. OBJECTIVE: To alert spine physicians to the rare combination of an odontoid and Jefferson fracture in a child. METHODS: A 5-year old boy presented with neck pain and torticollis after falling on his head from a four-wheeler that had rolled over. A computed tomography scan confirmed a combined odontoid and Jefferson fracture. RESULTS: The child was successfully treated nonsurgically with a hard cervical orthosis. At this writing, the child clinically is asymptomatic 2 years after the injury. DISCUSSION: The fall on to the head caused the body weight to be transmitted to the atlas. The resulting force vector produced the classic Jefferson fracture of the atlas. As the atlas fracture spread with continued compressive and axial forces, tension was exerted on the alar ligaments (check ligaments), leading to the avulsion fracture of the odontoid. CONCLUSIONS: This is only the second reported case of a child with a combined Jefferson and odontoid fracture. This diagnosis should be considered in the evaluation of a child with neck pain and torticollis from a fall on the top of the head.
Atlas anomalies in terms of clefts and aplasia are rare. They can sometimes simulate fractures and need further evaluation. Imaging in terms of CT and MR can help resolve diagnostic confusion and also outline associated neurological involvement. A rare anomaly of anterior and posterior atlas arch, previously unclassified, is presented.
Developmental symptomatic C1 canal stenosis is very rare. We describe the computed tomography (CT) and magnetic resonance imaging (MRI) appearances in a 8-year-old child who presented with progressive upper and lower limb neurological symptoms and in whom imaging revealed the medial posterior hemiarches of a bifid C1 to be inturned and compressing the cervical cord. This particular configuration of the posterior arch of atlas is frequently associated with other craniocervical bony anomalies and presents with neurological symptoms early in life. Early CT or MRI examination of patients with symptomatic posterior arch of C1 defects is necessary, in order to detect such an appearance, since surgical treatment may prevent neurological deterioration.