ArticleJournal of orthopaedic case reports2026
Bilateral Medial Medullary Syndrome Following Anterior Odontoid Screw Fixation for a Type II Fracture: A Case Report.
Article in Journal of orthopaedic case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Medial medullary syndrome is an uncommon brainstem stroke, and bilateral involvement is rarer still. It has not, to our knowledge, been described as a complication of anterior screw fixation for a type II odontoid fracture. Case Report: A 28-year-old man sustained a posteriorly displaced type II odontoid fracture with an associated C2 spinous process fracture in a road traffic accident. He was neurologically intact at admission. Surgery was briefly postponed after a transient episode of anisocoria during induction that resolved without deficit and with a normal computed tomography (CT) angiogram. Halo-ring traction was applied preoperatively for 3 days to achieve gradual fracture reduction, and anterior fixation with two cannulated lag screws was performed uneventfully. Weaning from ventilation was prolonged and complicated; cerebral CT was unremarkable, but magnetic resonance imaging (MRI) showed acute bilateral medial medullary ischemia. He developed a bilateral incomplete tetraparesis, predominantly left-sided, with pyramidal signs and a right hypoglossal palsy (American Spinal Injury Association [ASIA] C)]. Tracheostomy, gastrostomy feeding, anticoagulation, antiplatelet therapy, and early rehabilitation were instituted. Severe atherosclerosis of the bilateral vertebral and basilar arteries, in a patient with hypertension, dyslipidemia, and long-standing smoking, was the only etiological factor identified. At 6-month follow-up, he had improved to ASIA D and was ambulating short distances with a cane. Conclusion: Postoperative brainstem ischemia should be suspected whenever weaning fails or new deficits appear after upper cervical spine surgery, even with a normal CT; MRI with diffusion-weighted sequences is required to confirm the diagnosis. Perioperative manipulation of the cervical spine in a patient with underlying atherosclerosis may be an under-recognized mechanism for this rare complication.
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