Case Study: Surgical management of a 78 year old

with Odontoid Fracture Myelopathy

78 year old male presents with c/o bilateral hand clumsiness and balance problems. There is a remote history of fall about 4 years ago when he had neck pain and was treated in a cervical collar. There is no previous diagnosis of fracture.

He was having balance issues along with weakness in all 4 extremities. X rays, CT scan and MRI showed a non-union of odontoid fracture with pannus formation and fibrous union, instability with compression of spinal cord at C1-2 level.

AP and Lateral view of X rays showing a suspected odontoid fracture with instability at C1-2 AP and Lateral view of X rays showing a suspected odontoid fracture with instability at C1-2

CT scan of Cervical Spine showing non-union of odontoid with along with degenerative changes of Cervical spine CT scan of Cervical Spine showing non-union of odontoid with along with degenerative changes of Cervical spine

MRI of Cervical Spine showing critical stenosis at C1-2 with posterior fibrous pannus at odontoid fracture MRI of Cervical Spine showing critical stenosis at C1-2 with posterior fibrous pannus at odontoid fracture

After thorough discussion with the patient, an operative management was planned. Posterior C-12 decompression with stabilization with a C1-2 screw and rod fixation was performed.

Post-operative X-rays after C1-2 fusion and decompression surgery Post-operative X-rays after C1-2 fusion and decompression surgery

Patient started recovery in his neurological status post operatively and was sent to rehab. He recovered near complete strength and coordination in 3-4 months post operatively.

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Dr. Vedant Vaksha

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

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