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Minerva Medicolegale 2011 June;131(2):51-8


language: Italian

Os odontoideum death after cervical spine manipulation and virtopsy: a case report

Frustaci M. 2, Cavalli F. 1, Ruzza E. 1, Costantinides F. 2

1 Unità di Ricerca di Paleoradiologia e Scienze Affini, Azienda Ospedaliero-Universitaria di Trieste, Trieste, Italia; 2 Scuola di Specializzazione in Medicina Legale, Università di Trieste, Trieste, Italia


Os odontoideum is a congenital malformation of the cervical spine; its etiology is characterized by an incomplete fusion of the dens of C2 that is followed by the genesis of an oval ossicle strictly located to the anterior arch of C1. It is an important cause of instability of craniovertebral junction. In the performing of therapeutical spine manipulation it would be taken into account of the possible presence of this malformation that may be a well-known factor of important and serious injuries. Authors report a case of a woman 82-year-old who submit herself to cervical spine manipulation in a phisiatric surgery in Trieste. These manupulation caused a following clinical evolution in “spastic tetraparesis with spine contusion” ascribed to a fracture of the dens of C2, and a subsequently decease by a massive embolism of the pulmunary artery. The death, occurred some weeks after this previous diagnosis, arise the suspicion of a connection between the two events (spine manipulation and spine fracture followed by death) in terms of cause or pre-existing cause of death, with a possible prefessional sanitary responsability (professional guilt) to have performed this therapy to an old woman where subsist well-known relative or absolute contraindications and potential risks of serious complications of spine manipulation. Virtual autopsy, in support of the traditional examination, was performed by a multislice CT and besides other malformations not described by previous radiological examination, did not reveal the fracture of the dens of C2 but rather the presence of os odontoideum. A penal prosecution was established dependent on sanitary staff that performed manipulations but the authors believe that carried out virtual autopsy and its results, will be able to offer an important and decisive contribution to the resolution of a complicated legal case still in progress.

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