Abstract
Occipital condyle fractures (OCFs) have been treated as rare traumatic injuries, but the number of reported OCFs has gradually increased because of the popularization of computed tomography (CT) and magnetic resonance imaging (MRI). The patient in this report presented with OCFs and C1 dislocation, along with traumatic cerebellar hemorrhage, which led to craniovertebral junction instability. This case was also an extremely rare clinical condition in which the patient presented with traumatic lower cranial nerve palsy secondary to OCFs. When the patient was transferred to our hospital, the occipital bone remained defective extensively due to surgical treatment of cerebellar hemorrhage. For this reason, concurrent cranioplasty was performed with resin in order to fix the occipital bone plate strongly. The resin-made occipital bone was used to secure a titanium plate and screws enabled us to perform posterior fusion of the craniovertebral junction. Although the patient wore a halo vest for 3 months after surgery, lower cranial nerve symptoms, including not only neck pain but also paralysis of the throat and larynx, improved postoperatively. No complications were detected during outpatient follow-up, which continued for 5 years postoperatively.
Highlights
Head trauma can be accompanied by parenchymal brain damage; one study [1] reported that 4% of patients who experienced severe traumatic brain injuries, with severely impaired consciousness (Glasgow Coma Scale scores of 3–6 on admission), developed occipital condylar fractures (OCFs)
We found that the neck pain was largely due to craniovertebral junction instability because halo vest immobilization (HVI) relieved the pain
Cervical spine injuries require careful evaluation, craniovertebral junction injuries, such as OCFs, which can potentially lead to fatal outcomes or significant partial disability [8]
Summary
Head trauma can be accompanied by parenchymal brain damage; one study [1] reported that 4% of patients who experienced severe traumatic brain injuries, with severely impaired consciousness (Glasgow Coma Scale scores of 3–6 on admission), developed occipital condylar fractures (OCFs). It is known that OCFs lead to localized pain, limited range of motion, and severe nerve damage, especially lower cranial nerve (CN-IX to -XII) symptoms [4,5,6]. We experienced a case in which a patient return to normal activities of daily living after surgical treatment who experienced dislocation of the atlas (C1), fractures of the left occipital condyle, and a traumatic hemorrhagic cerebellar contusion in the left hemisphere caused by blunt head trauma. This is the first report of the simultaneous performance of cranioplasty and posterior fusion of the craniovertebral junction
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