Bilateral medial medullary syndrome following anterior screw fixation of type 2 odontoid fracture, a case report of two patients
Introduction Medial medullary syndrome (MMS) has not been reported after anterior screw fixation of an odontoid type 2 fracture. Case presentation We report on two cases who suffered from an unstable type 2 odontoid fracture following a skiing and a domestic fall accident. Prior to anterior screw fi...
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Published in | Spinal cord series and cases Vol. 7; no. 1; p. 101 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
London
Nature Publishing Group UK
20.11.2021
Nature Publishing Group |
Subjects | |
Online Access | Get full text |
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Summary: | Introduction
Medial medullary syndrome (MMS) has not been reported after anterior screw fixation of an odontoid type 2 fracture.
Case presentation
We report on two cases who suffered from an unstable type 2 odontoid fracture following a skiing and a domestic fall accident. Prior to anterior screw fixation surgery both patients presented without neurologic deficits but postoperatively developed a bilateral MMS, including an incomplete tetraparesis, impaired sensation of position and movement as well as tactile discrimination and paralysis of the tongue muscle with deviation to the paralyzed side. MRI showed a typical heart-shaped ischaemic lesion in the medial medulla bilaterally. The search for aetiologic factors was uneventful in both patients except for severe atherosclerosis.
Discussion
Due to the close proximity of the ischaemic area to the surgical site, we here propose the perioperative mechanical manipulation of the upper cervical spine during surgery of patients with atherosclerosis as a new aetiology for MMS. |
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Bibliography: | ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3 |
ISSN: | 2058-6124 2058-6124 |
DOI: | 10.1038/s41394-021-00462-x |