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1104 - A Pediatric Case of Os Odontoideum Subluxation Leading to Central Cord Syndrome While on a Rollercoaster Ride

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

JT

Jimmy To, DO

Resident Physician
University of Minnesota
Minneapolis, Minnesota, United States

Co-Author(s)

MG

Mark Gormley, Jr., MD

Attending Physician
Gillette Children's Hospital and Clinics
St. Paul, Minnesota, United States
MS

Matthew Severson, MD

Attending Physician
Gillette Children's Hospital and Clinics
St. Paul, Minnesota, United States

Case Diagnosis: Central Cord Syndrome due to Os Odontoideum Subluxation

Case Description: A 7-year-old previously healthy male sustained a traumatic upper cervical spinal cord injury (SCI) while riding a rollercoaster. He reportedly hyperextended his neck and momentarily lost consciousness. He experienced immediate onset of sensory loss and weakness in all four limbs. MRI imaging indicated a segment of spinal cord contusion with minimal hemorrhage extending from C1-C4 and translocation of a large os odontoideum. He underwent a C1-C2 posterior fusion and was transferred to a pediatric inpatient rehabilitation unit 2 weeks after injury. Examination was consistent with an ASIA Impairment Scale (AIS) D classification, with impaired sensation at C2 and greater weakness in the upper limbs than in the lower limbs. Spasticity was noted in the bilateral pronators, wrist flexion, hamstrings, and hip adductors. Patient was also bowel incontinent and required a daily bowel regimen. After 6 weeks of rehabilitation, the patient had improvement with motor strength, tone, ambulation, and bowel continence.

Discussions: Os odontoideum is a rare condition where the odontoid of the second cervical vertebra is separated from the rest of the vertebra, making an individual susceptible for spinal instability. The incidence and prevalence remain unclear. When discovered incidentally, management of asymptomatic os odontoideum is controversial. Options include clinical and radiological follow-up vs prophylactic spinal fusion. Symptomatic presentations are typically related to traumatic events that occur during childhood. Presentations vary but may include incomplete SCI syndromes such as central cord syndrome and Brown-Sequard syndrome, cardiopulmonary arrest, and more. Individuals who sustain SCI from os odontoideum subluxation may have physical deficits which would benefit from acute rehabilitation.

Conclusions: Os odontoideum subluxation is a rare cause of pediatric traumatic SCI. Rapid acceleration-deceleration activities may put an individual with spinal anomaly at greater risk of SCI. However, it is usually not diagnosed until an injury occurs.