An unexpected broken odontoid screw

Tsung‐Han Ho and Yaw‐Don Hsu
Med J Aust 2019; 210 (5): . || doi: 10.5694/mja2.13000
Published online: 18 March 2019

A 56‐year‐old man presented with a 2‐month history of continuous occipital pain that progressed to aching neck movements. He had had a prior odontoid fracture at 43 years of age, which was treated with cervical spine internal fixation and was subsequently uneventful. Serological tests including immunological panel and microbiological workup yielded negative results. Neurological examination revealed diffuse cervical tenderness without extremities weakness, and no evidence of Lhermitte sign or meningeal irritation. A lateral neck x‐ray film showed an odontoid screw breakage associated with an atlantoaxial subluxation (Figure). No myelopathic abnormalities were seen on cervical magnetic resonance imaging scan. He had a dramatic recovery after screw revision. This case highlights that appropriate workup and detailed history taking are crucial for management of an individual with head and neck pain.

  • Tri‐Service General Hospital, National Defense Medical Center, Taipei, Taiwan


Competing interests:

No relevant disclosures.


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