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Sudden onset odontoid fracture caused by cervical instability in hypotonic cerebral palsy

Tadashi Shiohama1, Katsunori Fujii, Katsuhiko Kitazawa

  • 1Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan; Department of Pediatrics, Asahi General Hospital, Chiba, Japan.

Brain & Development
|December 29, 2012
PubMed

Insights

Cerebral palsy (CP) patients with cervical instability may experience odontoid fractures from minor trauma. This case highlights a 4-year-old with hypotonic CP who developed a type-III odontoid fracture, leading to respiratory failure and requiring surgical intervention.

Area of Science:

  • Pediatric Orthopedics
  • Neurology
  • Rehabilitation Medicine

Background:

  • Cervical spine fractures, particularly odontoid fractures, are rare in children but associated with high mortality and neurological deficits.
  • Cerebral palsy (CP) can lead to cervical instability, increasing fracture risk even with mild trauma.
  • Hypotonic CP, characterized by low muscle tone, may exacerbate cervical instability.

Observation:

  • A 4-year-old boy with a history of hypotonic cerebral palsy presented with acute respiratory failure requiring mechanical ventilation.
  • Neuroimaging revealed a type-III odontoid fracture with anterior displacement and cervical spinal cord compression.
  • The patient exhibited significantly decreased bone mineral density, likely due to prolonged immobility and poor nutrition.

Findings:

  • This is the first reported case of an odontoid fracture in a child with hypotonic cerebral palsy secondary to cervical instability.
  • Surgical posterior internal fixation with an onlay bone graft successfully treated the fracture and resolved the respiratory failure.
  • The patient showed dramatic improvement in respiratory function post-surgery.

Implications:

  • Cervical instability and reduced bone mineral density are common in CP patients, necessitating vigilance for spinal fractures.
  • Sudden respiratory failure or worsening weakness in children with CP, especially hypotonic types, warrants careful evaluation for odontoid fractures.
  • Early diagnosis and surgical management of odontoid fractures in this vulnerable population can prevent severe neurological complications and improve outcomes.

Keywords:
Hypotonic cerebral palsyOdontoid fractureOsteoporosisRespiratory failure

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