Posterior cervical arthrodesis for subacute odontoid fracture in a patient with osteopetrosis: case report.

STUDY

DESIGN

A case of subacute odontoid fracture in a patient with osteopetrosis treated with posterior cervical arthrodesis using transarticular screws and interspinous wiring.

OBJECTIVES

To report the first successful cervical arthrodesis in a patient with osteopetrosis and to highlight the potential perioperative pitfalls in this rare surgical population.

SUMMARY OF BACKGROUND DATA: Osteopetrosis is a group of skeletal dysplasias characterized by osteoclast dysfunction, impaired bone resorption, and poor bone remodeling. Unique challenges associated with surgical fixation in osteopetrotic bone include a high incidence of nonunion, intraoperative fractures, intraoperative instrumentation failure, infection, and prosthesis loosening. We report the case of a patient with a subacute odontoid fracture treated successfully with posterior cervical arthrodesis using transarticular screws and interspinous wiring.

METHODS

The surgical technique, intraoperative pitfalls, and 2-year follow-up data are reported.

RESULTS

The patient underwent a successful posterior cervical arthrodesis using transarticular screws and interspinous wiring with autogenous iliac crest graft. At 2 years, a stable fixation was achieved with only mild postoperative limitation in neck range of motion.

CONCLUSIONS

Cervical fractures and instability that require surgery in patients with osteopetrosis represent a unique challenge to the orthopedic spine surgeon. Despite the increased potential for perioperative instrumentation complications, nonunion, and infection, posterior cervical arthrodesis can be achieved and should be considered in the treatment armamentarium for this potentially catastrophic injury.