Abstract
We report a case of pathologic fracture at the odontoid process in a hemodialysis patient surgically treated in 2002.
The 65 year-old man had a diagnosis of diabetes mellitus at age 33 years, and started hemodialysis for chronic kidney failure at age 51 years. The patient complained of severe pain at the back of his neck when put on his socks.
A pathological fracture of the odontoid process and a retro-odontoid pseudotumor were detected. The instability at the C1/2 level was ADI=1 mm and SAC=19 mm at the extension position,and ADI=7 mm and SAC=13 mm at the flexion position. The osteolysis and fracture appeared at the base under the odontoid process on three-dimensional CT.
The patient underwent transarticular fixation by Magerl technique with atlas claw hook, and bone graft without laminectomy of C1 vertebra. He wore a soft collar on his neck for four weeks.
One year later, the pain at the nape of his neck had improved,and he was free of neurological signs. Bone union between C1/2 appeared on the radiographys. However the retro-odontoid pseudotumor showed no change in size MRI 9 months after surgery.
This case indicates a possibility exists for the spontaneous pathologic fracture of the odontoid process in patients in long-term hemodialysis.
