What is the best treatment option for cervical spinal cord injury by os odontoideum in a patient with athetoid dystonic cerebral palsy?

Abstract

Context: Atlantoaxial instability in an athetoid dystonic cerebral palsy patient due to os odentoideum represents a rare cause of high-level cervical spinal cord injury. There is no evidence-based treatment protocol for this injury and a number of reports have debated whether nonsurgical or surgical treatment is the best option.Findings: Here, we report the case of a 32-year-old athetoid dystonic cerebral palsy patient with os odontoideum (OO) causing compressive myelopathy on the C1-2 levels. About two weeks after atlantoaxial fusion, the patient started an intensive rehabilitation program and maintained it for four weeks. He showed neurological and functional improvement at discharge after four weeks of training. There were further improvements in function and symptoms four weeks after discharge.Conclusion: Intensive rehabilitation programs are important for the recovery and good prognosis in spinal cord injury patients. However, rehabilitation of CP patients with spinal cord injury is often neglected. We provided intensive rehabilitation therapy to a patient for a cervical spinal cord injury by OO with athetoid dystonic cerebral palsy and achieved neurological and functional recovery.

Keywords: Athetoid dystonic cerebral palsy; Os odontoideum; Rehabilitation; Spinal cord injury.

Figure 1.

Cervical spine radiographs (A) and cervical spine CT (B) images showing an os odontoideum. Flexion and extension radiographs (A) demonstrating a C1–C2 instability (Red circle). Cervical spine MRI (C) images showing an unstable C1–C2 region and spinal cord compression at the C1–2 level.

Figure 2.

Cervical spine radiography images six weeks postoperatively. The patient underwent posterior fusion on the C1 and C2 vertebrae.