Saved By The Bell Being Rung

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Saved By The Bell Being Rung - Page #3

Lab Studies: N/A Other Studies: Flexion/Extension Cervical Spine radiographs with Open Mouth Odontoid showed mild instability is seen at the atlantoaxial joint increased with airspace within the odontoid and the artifact last on the flexion view. There was a slight reversal of cervical lordosis. After multiple attempts, open-mouth views are not optimal for evaluation. Case Photo #1 Case Photo #2 MRI Cervical Spine without Contrast showed an accessory os odontoideum with a wide gap between C2 and the accessory os containing fluid. There was mild posterior subluxation of C1-C2, suggestive of atlantoaxial instability. Case Photo #3 Spinal cord signal was normal. Consultations: Neurosurgery was consulted and felt the patient had multiple episodes of transient quadriparesis in the setting of Atlantoaxial instability secondary to a likely dystopic type os odontoideum in which the fragment of the dens is likely fused to the C1 ring with retroflexion of the dens without evidence of cord injury or myelomalacia. Given his age and level of activity along with his history of at least two episodes of likely transient cord injury and clear instability on his flexion-extension films, operative fixation and fusion via C1-2 instrumentation was recommended. He cannot safely participate in football, wrestling, boxing, or any other high contact activity with or without surgery. Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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