1318. Non-traumatic fracture and subluxation of the odontoid process: A rare Presentation in a Child with Acute Lymphocytic Leukemia

Authors: Sanaullah Bashir, MBBS; Gohar Javed; Narmeen Masood (karachi, Pakistan)

Abstract: Acute lymphoblastic leukemia is one of the most common childhood cancer. There are number of bony pathologies that are common in leukemia, probably due to osteo-blastic and osteo-clastic disruption. The bones most commonly affected are the appendicular and weight bearing lower extremities. Clinical trials have shown 26.4% incidence of vertebral fractures in patients with acute lymphoblastic leukemia. Majority of the fracture were of thoracic and lumbar. Fracture of the cervical spine has not yet documented in literature. Here is the first case of non-traumatic fracture and subluxation of the odontoid process in a patient suffering from acute lymphoblastic leukemia. Case presentation: We present a case of 3 year old boy is being treated for acute lymphoblastic leukemia presented in our clinic with neck pain and restricted range of neck movements. There is no history of trauma. On examination, he is myelopathic with no neurological deficit. Imaging showed fracture of odontoid with anterior subluxation. He underwent staged procedure of trans-oral odontoid-ectomy followed by C1 /C2 lateral mass fusion. Postoperatively, he developed Cerebrospinal fluid discharge from the posterior wound which was managed conservatively. On follow-up visits, his myelopathy has improved and is now carrying out his daily activities.