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J Neurosurg Pediatr. 2019 Nov 1:1-4. doi: 10.3171/2019.8.PEDS18517. [Epub ahead of print]

Management of an odontoid synchondrosis fracture causing chronic translational anterior atlanto-axial subluxation in a child with autism: case report.

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1Division of Neurosurgery, Arkansas Children's Hospital.
Departments of3Neurosurgery and.
2Department of Otolaryngology-Head and Neck Surgery, Arkansas Children's Hospital and University of Arkansas for Medical Sciences; and.
4Neurological Surgery-Spine Division, University of Arkansas for Medical Sciences, Little Rock, Arkansas.


The authors report an unusual case of an odontoid synchondrosis fracture causing chronic translational anterior atlanto-axial subluxation and present a discussion of the unique management of this case. Traumatic translational anterior atlanto-axial subluxation is a rare manifestation within pediatrics. Patients with preexisting abnormalities in ligamentous or bony structures may present with unusual symptomatology, which could result in delay of treatment. A 6-year-old male patient with autism who presented with acute respiratory arrest was noted to have an odontoid synchondrosis fracture and severe anterior translational atlanto-axial subluxation. Initial attempts at reduction with halo traction were tried for first-line treatment. However, because of concern regarding possible inadvertent worsening of the impingement, the presence of comorbid macrocephaly, and possible instability with only C1-2 fusion, a posterior C1 laminectomy was performed. Further release of the C1-2 complex and odontoid peg from extensive fibrous tissue allowed for complete reduction. Acute injuries of the C1-2 complex may not present as expected, and the presence of pain is not a reliable symptom. Halo traction is an appropriate initial treatment, but some patients may require surgical realignment and stabilization.


MEP = motor evoked potential; SSEP = somatosensory evoked potential; chronic; fracture; odontoid; spine; subluxation; tAAS = translational atlanto-axial subluxation


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