An Atraumatic Fracture of the Odontoid Process in a Newly Diagnosed Rheumatoid Arthritis Patient

Doo-Ho Lim; Seung-Hyeon Bae; Jong Han Choi; Dong Hui Cho; Yong-Gil Kim; Chang-Keun Lee; Bin Yoo

doi:10.4078/jrd.2015.22.2.102

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Lim, Bae, Choi, Cho, Kim, Lee, and Yoo: An Atraumatic Fracture of the Odontoid Process in a Newly Diagnosed Rheumatoid Arthritis Patient

Case Report

J Rheum Dis 2015;22(2):102-105.

Published online: 31 October 2015

DOI: https://doi.org/10.4078/jrd.2015.22.2.102

An Atraumatic Fracture of the Odontoid Process in a Newly Diagnosed Rheumatoid Arthritis Patient

Doo-Ho Lim, Seung-Hyeon Bae, Jong Han Choi, Dong Hui Cho, Yong-Gil Kim, Chang-Keun Lee, Bin Yoo

Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Corresponding to: Yong-Gil Kim, Division of Rheumatology, Department of Internal Medicine Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. E-mail: bestmd2000@amc.seoul.kr.

Received 3 March 2014 Revised 30 April 2014 Accepted 14 May 2014

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Rheumatoid arthritis (RA) is a systemic autoimmune disorder which can affect all of the synovial joints including the cervical spine. Cervical involvement typically begins early in the disease process and shows relatively slow progression. Fractures of the odontoid process are mainly noted after a major trauma to the cervical spine. A case of a 77-year-old woman with paresthesia of the extremities caused by spontaneous atraumatic fracture of the odontoid process, which was revealed as a manifestation of RA, is presented in this report.

Keywords: Spontaneous fractures, Odontoid process, Rheumatoid arthritis

REFERENCES

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Figure 1.

Plain radiographs of both hands showed a marginal bone erosion in the left 5th metacarpophalangeal joint (A; white arrow) and joint space narrowing with marginal bone erosion in the right 4th and 5th proximal interphalangeal joints (B; white arrows).

Figure 2.

Lateral radiographs of the cervical spine in flexion (A) and extension (B). In flexion, the distance between the posterior aspect of the anterior ring of atlas and the anterior surface of the odontoid process (arrowheads) was 6 mm and showed atlantoaxial subluxation. Computed tomography scanning revealed a fracture of the odontoid process (C and D; white arrows). T2 weighted sagittal magnetic resonance imaging revealed C2 level spinal cord compression (E; white arrow).

Figure 3.

Postoperative lateral plain radiograph of the cervical spine showing posterior occipital-C4 fusion.

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