Progressive quadriparesis caused by anterior odontoid screw upward migration in rheumatoid arthritis

Abstract

A 70-year-old male known for seropositive rheumatoid arthritis underwent placement of an anterior odontoid screw in 2005 at an outside hospital for a posttraumatic type 2 odontoid fracture (Fig. 1). At the time of the accident, he did not have documented rheumatoid changes in the cervical spine. A postoperative lateral radiograph showed the screw going beyond the distal cortex of the dens (Fig. 2). The patient initially did well and was subsequently lost to follow-up. Fig. 2Sagittal computed tomography (CT) scan reconstruction performed after anterior odontoid screw fixation with satisfactory reduction of odontoid fragment. Despite a screw going 3 mm beyond odontoid tip, it remains extracranial, below the McRae line (dotted line). View Large Image Figure Viewer Download Hi-res image