Abstract
The authors report a very rare case of bilateral occipital condyle fractures (OCF) that was associated with complete separation fracture of the inferior clivus resulting in craniocervical dislocation alongside dissociation of C1–C2 joint complex. Also, a new type of the Anderson and Montesano classification system is presented with two subtypes of injuries. Type IVA occurs when the OCF is associated a clivus avulsion fracture, while Type IVB occurs when the OCF is associated with complete “en piece” separation fracture of the inferior clivus. Both Type IV injuries are considered highly unstable, and surgical fixation is the recommended treatment option.
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The authors declare not having funding or any conflict of interest. The present study was done at the Spine Department of London Bridge Hospital. The patient involved in this study gave authorization and now lives in Qatar.
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The authors present an unusual fracture pattern of the occipital clivus area consisting of bilateral occipital condyle fractures and inferior clivus separation fracture, as well as C1-C2 dislocation. The patient was treated by halo and then, several days later, surgical fixation was carried out. Surprisingly, at two years, the patient had completely normal neurological examination. Present classifications do not describe this fracture subtype, and the authors propose a novel Type IV injury by dividing it to two types: Type IVA occurs when the occipital condyle fractures (OCF) is associated a clivus avulsion, and Type IVB when the OCF is associated with “en piece” fracture of the clivus. Certainly, this is an unusual fracture pattern, and I congratulate the authors on the excellent outcome.
Volker Sonntag
Phoenix, Arizona, USA
This article is part of the Topical Collection on Spine trauma
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Lam, K.S., Carriço, G., Fernandes, F.M. et al. A rare case of bilateral occipital condyle fractures associated with inferior clivus separation fracture resulting in craniocervical dislocation: a case report and modification of the Anderson and Montesano classification is proposed. Acta Neurochir 163, 2307–2311 (2021). https://doi.org/10.1007/s00701-021-04855-7
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DOI: https://doi.org/10.1007/s00701-021-04855-7