{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T12:56:30Z","timestamp":1791377790082,"version":"4.3.2"},"reference-count":0,"publisher":"Indian Orthopaedic Research Group","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Jocr"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:p>Introduction:\nMedial 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.\n\nCase Report:\nA 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.\n\nConclusion:\nPostoperative 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.\n\nKeywords:\nOdontoid fracture , medial medullary syndrome , anterior screw fixation , brainstem infarction , cervical spine trauma , atherosclerosis<\/jats:p>","DOI":"10.13107\/jocr.2026.v16.i10.8256","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:59:26Z","timestamp":1791374366000},"page":"252-259","source":"Crossref","is-referenced-by-count":0,"title":["Bilateral Medial Medullary Syndrome Following Anterior Odontoid Screw Fixation for a Type II Fracture: A Case Report"],"prefix":"10.13107","volume":"16","author":[{"given":"Sharath","family":"Raj","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aashish Kumar","family":"Sen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saloni Rani","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay G","family":"Goni","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5271","published-online":{"date-parts":[[2026]]},"container-title":["Journal of Orthopaedic Case Reports"],"original-title":[],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:59:29Z","timestamp":1791374369000},"score":1,"resource":{"primary":{"URL":"https:\/\/jocr.co.in\/wp\/2026\/10\/bilateral-medial-medullary-syndrome-following-anterior-odontoid-screw-fixation-for-a-type-ii-fracture-a-case-report\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":0,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026]]},"published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.13107\/jocr.2026.v16.i10.8256","relation":{},"ISSN":["2321-3817"],"issn-type":[{"value":"2321-3817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]}}}