Occipital condyle fractures: a hidden nosologic entity. An experience with 10 cases.

Abstract

To report the incidence, treatment and outcome of occipital condyle fractures (OCFs) based on the experience of a single neurosurgical department over a period of two years. From April 1999 to April 2001, ten cases of OCFs were identified in 110 cervical traumas observed over a period of two years. Patients were studied by cervical x-rays, high-resolution CT scan with a 1-2 mm slice of the cranio-cervical junction (CCJ) and MRI in selected cases to evaluate the integrity of supporting ligaments. According to the Anderson and Montesano classification, 5 cases of type III, 3 cases of type II and 2 cases of type I fractures were found. Dysfunction of lower cranial nerves was observed in 8 cases. Treatment was conservative in all cases. At follow-up, ranging from 18 months to 2 years, fusion was obtained in all cases; 8 patients were neurologically intact, one patient presented a mild persistent dysphonia and another mild trapezius weakness. OCFs are actually not rare, rather they are often overlooked. In cases of high-energy trauma of the cervical spine, the diagnostic suspicion should be kept in mind.High-resolution CT scan with slice at 1-2 mm of the CCJ is the key radiological examination in the diagnosis of this lesion. Conservative treatment using a hard collar is sufficient to obtain sound fusion.