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Bilateral Medial Medullary Syndrome Following Anterior Screw Fixation of Type 2 Odontoid Fracture: A Case Report of Two Patients

 

Bilateral Medial Medullary Syndrome Following Anterior Screw Fixation of Type 2 Odontoid Fracture: A Case Report of Two Patients

Michael Zegg1, Anna Spicher1, Bettina Pfausler2, Martha Nowosielski2*, Dietmar Krappinger1

1Department of Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
2Department of Neurology, Medical University Innsbruck, Innsbruck, Austria

*Corresponding author: Dr. Martha Nowosielski, Department of Neurology, Medical University Innsbruck, Innsbruck, Austria, E-mail: nowosielski.m@i-med.ac.at

Received: April 21, 2021; Accepted: May 02, 2021; Published: May 16, 2021

Citation: Zegg M, Spicher A, Pfausler B, et al. Bilateral Medial Medullary Syndrome Following Anterior Screw Fixation of Type 2 Odontoid Fracture, A Case Report of Two Patients. Clin Image Case Rep J. 2021; 3(5): 167.

Abstract

We report on two cases who suffered from an unstable type 2 odontoid fracture following a skiing and a domestic fall accident. Prior to anterior screw fixation surgery both patients presented without neurologic deficits but postoperatively developed a bilateral me-dial medullary syndrome (MMS), including an incomplete tetraparesis, impaired sensation of position and movement as well as tactile discrimination and paralysis of the tongue muscle with deviation to the paralyzed side. MRI showed a typical heart-shaped ischemic lesion in the medial medulla bilaterally. The search for aetiologic factors was uneventful in both patients except for severe atherosclerosis. MMS has not been reported after ante-rior screw fixation of an odontoid type 2 fracture. Due to the close proximity of the ischemic area to the surgical site we here propose the perioperative mechanical manipulation of the upper cervical spine during surgery as a new etiology for MMS.

Keywords: Bilateral medial medullary syndrome; Type 2 odontoid fracture; Anterior screw fixation; Stroke etiology

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