Management of acute cervical compression fractures in two patients with osteogenesis imperfecta.
Overview
abstract
STUDY DESIGN: We report 2 cases of acute cervical compression fracture in patients with osteogenesis imperfecta (OI). In case 1, a 15-year-old girl with an acute C6 compression fracture and additional fractures of the posterior elements underwent a C6 corpectomy and instrumented posterior fusion. In case 2, a 46-year-old man with a C7 compression fracture was managed nonoperatively. OBJECTIVE: To illustrate a subset of possible acute subaxial cervical fractures in OI patients and to describe the feasibility of performing a combined anterior/posterior cervical decompression and fusion in an OI patient. SUMMARY OF BACKGROUND DATA: OI is a rare genetic collagen disorder that is characterized by bone fragility and ligamentous laxity. Spinal complications associated with this disease included scoliosis, thoracolumbar compression fractures, and other spinal fractures, cervical spondyloptosis, and basilar invagination. There is limited literature that addresses the management of acute cervical spine fractures in OI patients. METHODS: In case 1, the patient was initially treated with a Minerva brace. Nonoperative management was abandoned when a progressive kyphotic deformity developed. A C6 corpectomy and placement of a fibular strut allograft was followed by a C4-C7 posterior fusion with sublaminar wiring and rods. In case 2, the patient was managed nonoperatively with a rigid cervical collar alone. RESULTS: In case 1, the patient made a prompt recovery, and on 12-month follow-up has maintained alignment. In case 2, the patient maintained normal alignment without need for surgical intervention. CONCLUSION: A combined anterior/posterior decompression and fusion of the subaxial cervical spine is feasible in the fragile OI population. Moreover, certain isolated compression fractures of the subaxial cervical spine in this same patient population may be managed nonoperatively.
