{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T01:19:51Z","timestamp":1787707191553,"version":"build-2784847793"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"8","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,8,24]]},"abstract":"\n BACKGROUND<\/jats:title>\n Osteopetrosis is a rare skeletal dysplasia characterized by impaired osteoclastic bone resorption, leading to dense but brittle bones prone to pathological fractures. Although fractures in the appendicular skeleton are well described, cervical spine involvement, particularly atlantoaxial rotatory subluxation is rare in children.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors present the case of a 7-year-old boy with autosomal recessive osteopetrosis who developed torticollis and restricted neck motion following minor trauma. Imaging revealed rotatory C1\u20132 subluxation with bilateral C2 pars interarticularis fractures. Surgical fixation was performed using a posterior C1\u20132 approach with lateral mass and pars screws. Low-speed drilling and avoidance of malleting were used because of sclerotic bone. The construct was augmented with autologous graft and demineralized bone matrix. The patient achieved early postoperative mobilization and resolution of torticollis and maintained neurological integrity throughout follow-up.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case represents the first reported pediatric case of osteopetrosis with combined rotatory C1\u20132 instability and bilateral pars fractures with nonunion, and it was managed successfully with isolated posterior fixation. It highlights the feasibility and safety of surgical stabilization in carefully selected cases of chronic instability despite the challenging bone biology. This report expands the current understanding of cervical spine trauma in osteopetrosis and offers technical guidance for operative planning.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE26479<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case26479","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:01:12Z","timestamp":1787097672000},"source":"Crossref","is-referenced-by-count":0,"title":["Atlantoaxial rotatory subluxation in a pediatric patient with osteopetrosis following minor trauma: illustrative case"],"prefix":"10.3171","volume":"12","author":[{"given":"Emad M.","family":"Babateen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Security Forces Hospital, Riyadh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Y.","family":"Madkhali","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Jazan University, Jazan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed A.","family":"Mehrez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Security Forces Hospital, Riyadh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed M.","family":"Aly","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Prince Mohammed bin Abdulaziz Hospital, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed J.","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Security Forces Hospital, Riyadh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"Curr Osteoporos Rep","first-page":"13","article-title":"Genetics of osteopetrosis","volume":"16","author":"Palagano","year":"2018","unstructured":"Palagano EMenale CSobacchi CVilla A.Genetics of osteopetrosis. Curr Osteoporos Rep. 2018;16(1):13-25. doi:10.1007\/s11914-018-0415-2"},{"issue":"1","key":"bib2","series-title":"J Biomed Res","first-page":"68","article-title":"Cervical spine fractures in osteopetrosis: a case report and review of the literature","volume":"32","author":"Ahmadpour","year":"2018","unstructured":"Ahmadpour AGoodarzi ALee DJPanchal RRKim KD.Cervical spine fractures in osteopetrosis: a case report and review of the literature. J Biomed Res. 2018;32(1):68-76. doi:10.7555\/JBR.32.20170055"},{"issue":"213","key":"bib3","series-title":"Clin Orthop Relat Res","first-page":"232","article-title":"Stress fracture of the vertebral arch in osteopetrosis","author":"Suzuki","year":"1986","unstructured":"Suzuki SAwaya G.Stress fracture of the vertebral arch in osteopetrosis. Clin Orthop Relat Res. 1986;(213):232-236. doi:10.1097\/00003086-198612000-00033"},{"issue":"3","key":"bib4","series-title":"J Bone Joint Surg Br","first-page":"428","article-title":"Spondylolysis in osteopetrosis","volume":"70","author":"Szappanos","year":"1988","unstructured":"Szappanos LSzepesi KThom\u00e1zy V.Spondylolysis in osteopetrosis. J Bone Joint Surg Br. 1988;70(3):428-430. doi:10.1302\/0301-620X.70B3.3372566"},{"issue":"11","key":"bib5","series-title":"J Bone Joint Surg Am","first-page":"1685","article-title":"Spondylolysis in children who have osteopetrosis","volume":"79","author":"Martin","year":"1997","unstructured":"Martin RPDeane RHCollett V.Spondylolysis in children who have osteopetrosis. J Bone Joint Surg Am. 1997;79(11):1685-1689. doi:10.2106\/00004623-199711000-00010"},{"issue":"1","key":"bib6","series-title":"J Pediatr Orthop","first-page":"122","article-title":"Orthopedic management of osteopetrosis: results of a survey and review of the literature","volume":"19","author":"Armstrong","year":"1999","unstructured":"Armstrong DGNewfield JTGillespie R.Orthopedic management of osteopetrosis: results of a survey and review of the literature. J Pediatr Orthop. 1999;19(1):122-132. doi:10.1097\/01241398-199901000-00026"},{"issue":"1","key":"bib7","series-title":"Spine (Phila Pa 1976)","first-page":"E34","article-title":"Posterior cervical arthrodesis for subacute odontoid fracture in a patient with osteopetrosis: case report","volume":"32","author":"Auerbach","year":"2007","unstructured":"Auerbach JDMcCormick FLMehta SBrummett RSRushton SA.Posterior cervical arthrodesis for subacute odontoid fracture in a patient with osteopetrosis: case report. Spine (Phila Pa 1976). 2007;32(1):E34-E38. doi:10.1097\/01.brs.0000250249.42858.55"},{"issue":"6","key":"bib8","series-title":"Arch Orthop Trauma Surg","first-page":"783","article-title":"Anterior cervical arthrodesis for chronic hangman\u2019s fracture in a patient with osteopetrosis: a case report","volume":"138","author":"Yamane","year":"2018","unstructured":"Yamane KKai N.Anterior cervical arthrodesis for chronic hangman\u2019s fracture in a patient with osteopetrosis: a case report. Arch Orthop Trauma Surg. 2018;138(6):783-789. doi:10.1007\/s00402-018-2901-5"},{"key":"bib9","series-title":"World Neurosurg","first-page":"370","article-title":"Hangman\u2019s fracture in a child with osteopetrosis","volume":"139","author":"Shah","year":"2020","unstructured":"Shah ADandpat SGoel A.Hangman\u2019s fracture in a child with osteopetrosis. World Neurosurg. 2020;139:370-372. doi:10.1016\/j.wneu.2020.04.137"},{"issue":"2","key":"bib10","series-title":"Cureus","first-page":"e79471","article-title":"Spontaneous anterior arch fracture of the atlas following C1 laminectomy in a patient with osteopetrosis: a case with five years of follow-up","volume":"17","author":"Ishihama","year":"2025","unstructured":"Ishihama YIkeda TIemura SToriumi KGoto K.Spontaneous anterior arch fracture of the atlas following C1 laminectomy in a patient with osteopetrosis: a case with five years of follow-up. Cureus. 2025;17(2):e79471. doi:10.7759\/cureus.79471"},{"issue":"2","key":"bib11","series-title":"Asian J Neurosurg","first-page":"307","article-title":"Multi-level cervical spine fractures in osteopetrosis: a case report","volume":"12","author":"Rathod","year":"2017","unstructured":"Rathod AKSreedharan SThankachen BMenon VV.Multi-level cervical spine fractures in osteopetrosis: a case report. Asian J Neurosurg. 2017;12(2):307-309. doi:10.4103\/1793-5482.174709"},{"issue":"11","key":"bib12","series-title":"Genes (Basel)","first-page":"1965","article-title":"Spectrum of skeletal imaging features in osteopetrosis: inheritance pattern and radiological associations","volume":"13","author":"Spinnato","year":"2022","unstructured":"Spinnato PPedrini EPetrera MRSpectrum of skeletal imaging features in osteopetrosis: inheritance pattern and radiological associations. Genes (Basel). 2022;13(11):1965. doi:10.3390\/genes13111965"},{"issue":"5","key":"bib13","series-title":"Neurosurgery","first-page":"941","article-title":"Atlantoaxial rotatory fixation: part 2. New diagnostic paradigm and a new classification based on motion analysis using computed tomographic imaging","volume":"57","author":"Pang","year":"2005","unstructured":"Pang DLi V.Atlantoaxial rotatory fixation: part 2. New diagnostic paradigm and a new classification based on motion analysis using computed tomographic imaging. Neurosurgery. 2005;57(5):941-941. doi:10.1227\/01.NEU.0000181309.13211.3A"},{"issue":"20","key":"bib14","series-title":"Spine (Phila Pa 1976)","first-page":"2174","article-title":"Current management of pediatric atlantoaxial rotatory subluxation","volume":"23","author":"Subach","year":"1998","unstructured":"Subach BRMcLaughlin MRAlbright ALPollack IF.Current management of pediatric atlantoaxial rotatory subluxation. Spine (Phila Pa 1976). 1998;23(20):2174-2179. doi:10.1097\/00007632-199810150-00006"},{"issue":"1-2","key":"bib15","series-title":"Acta Neurochir (Wien)","first-page":"47","article-title":"Plate and screw fixation for atlanto-axial subluxation","volume":"129","author":"Goel","year":"1994","unstructured":"Goel ALaheri V.Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien). 1994;129(1-2):47-53. doi:10.1007\/BF01400872"},{"issue":"22","key":"bib16","series-title":"Spine (Phila Pa 1976)","first-page":"2467","article-title":"Posterior C1-C2 fusion with polyaxial screw and rod fixation","volume":"26","author":"Harms","year":"2001","unstructured":"Harms JMelcher RP.Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976). 2001;26(22):2467-2471. doi:10.1097\/00007632-200111150-00014"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/8\/article-CASE26479.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/8\/article-CASE26479.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/8\/article-CASE26479.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:38:04Z","timestamp":1787704684000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/8\/article-CASE26479.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":16,"journal-issue":{"issue":"8"},"URL":"https:\/\/doi.org\/10.3171\/case26479","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]}}}