Unusual spinal metastases from an adenoid cystic carcinoma of the maxillary sinus.

Adenoid cystic carcinoma (ACC), the second most common cancer occurring in the sinonasal tract, is an aggressive malignancy with a poor five-year survival rate. Spinal metastases to the vertebral column related to this cancer are rare. This report presents a patient with maxillary sinus carcinoma with vertebral metastases at the thoracic level and compression of the spinal cord seven years after surgical resection of the primary tumor. Eleven years after detection of the primary tumor the patient is still able to walk. The role of decompression and/or fusion in spinal metastases with neurologic deficits is still under debate, although recent studies have confirmed the beneficial role of surgical intervention in selected patients. This report represents an example of modern individual treatment of an aggressive tumor in a palliative situation. The epidemiology, clinical findings, treatment and outcome of this atypical distant metastasis in long-term survivors are presented.

[Atypical dislocated dens fracture type II with rotational atlantoaxial luxation after a riding accident]. / Atypische dislozierte Densfraktur Typ II mit rotatorischer atlantoaxialer Luxation nach Reitunfall.

We present a rare case of a combined dislocated odontoid dens fracture type II (Anderson/D'Alonzo) and rotational atlantoaxial luxation in a 15-year-old girl who was involved in a riding accident.She fell off her horse after it had stopped suddenly, losing consciousness for a few minutes. At presentation in the hospital, she had no complaints other than limited, painful neck movement. Radiologically, a posterior dislocation of an odontoid type II fracture (Anderson/D'Alonzo) was found. Computed tomography reconstruction demonstrated a rotational, hooklike fixed luxation of the left atlantoaxial facet joint. Manual repositioning after application of a cervical collar failed. Therefore, operative treatment was indicated for this highly unstable fracture. Posterior transarticular atlantoaxial screw fixation according to Magerl was performed; an iliac corticocancellous bone graft was harvested and shaped to conform to the posterior processes of C1 and C2. Additionally a hook-claw atlas fixation of C1 was done.To our knowledge, this is the first case of adolescent atlantoaxial cervical spine trauma in combination with an odontoid fracture and fixed rotational luxation reported in literature.