Unstable Os Odontoideum

Area of Science:

• Orthopedics
• Physical Therapy
• Radiology

Background:

• Direct-access physical therapy allows patients to seek care without physician referral.
• Cervical spine trauma can lead to various neurological deficits.
• Paresthesia, often described as a "pins and needles" sensation, can indicate nerve involvement.

Observation:

• A 24-year-old male Marine presented with bilateral hand paresthesia after a parachuting incident.
• The patient reported neck hyperextension during the accident.
• Neurological findings and trauma history prompted imaging of the cervical spine.

Findings:

• Standard radiographs did not clearly visualize the odontoid process.
• Computed tomography (CT) imaging confirmed the presence of os odontoideum.
• Os odontoideum is a developmental anomaly where the odontoid process is separate from the axis vertebra.

Implications:

• This case highlights the importance of advanced imaging when initial radiographs are inconclusive for cervical spine trauma.
• Os odontoideum can predispose individuals to atlantoaxial instability and neurological compromise.
• Physical therapists in direct-access settings must be vigilant in identifying potential red flags for serious spinal pathology.