Challenges in Occipitocervical Fusion in a 9-Month-Old Infant: A Case Report and Review of Literature

Traumatic cranio-cervical junction injuries in infants are rare and require early surgical stabilization. In view of the unique anatomy of the occipitocervical junction in infants, the creation of a fusion construct that is both safe and biomechanically sound is challenging. A 9-month-old male infant involved in an accident presented with weakness in both upper limbs. Imaging revealed a displaced odontoid synchondrosis fracture with combined occipitocervical and atlantoaxial dissociation. Due to the unstable nature of the injury, occiput to C2 arthrodesis using dual distal radius locking plates and autologous full-thickness parietal region calvarial bone graft was performed. Minerva jacket was applied. Computed tomography (CT) scan obtained at 12 weeks demonstrated evidence of bony fusion. Combined injuries to the occipitocervical and atlantoaxial joint in an infant can be fatal. A thorough assessment of multiple imaging modalities helps to make an early and accurate diagnosis.