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Lee S, Kim DH, Choi YH. What is the best treatment option for cervical spinal cord injury by os odontoideum in a patient with athetoid dystonic cerebral palsy? J Spinal Cord Med 2021; 44:1019-1023. [PMID: 31916917 PMCID: PMC8725757 DOI: 10.1080/10790268.2019.1706289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Context: Atlantoaxial instability in an athetoid dystonic cerebral palsy patient due to os odentoideum represents a rare cause of high-level cervical spinal cord injury. There is no evidence-based treatment protocol for this injury and a number of reports have debated whether nonsurgical or surgical treatment is the best option.Findings: Here, we report the case of a 32-year-old athetoid dystonic cerebral palsy patient with os odontoideum (OO) causing compressive myelopathy on the C1-2 levels. About two weeks after atlantoaxial fusion, the patient started an intensive rehabilitation program and maintained it for four weeks. He showed neurological and functional improvement at discharge after four weeks of training. There were further improvements in function and symptoms four weeks after discharge.Conclusion: Intensive rehabilitation programs are important for the recovery and good prognosis in spinal cord injury patients. However, rehabilitation of CP patients with spinal cord injury is often neglected. We provided intensive rehabilitation therapy to a patient for a cervical spinal cord injury by OO with athetoid dystonic cerebral palsy and achieved neurological and functional recovery.
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Affiliation(s)
- Sungche Lee
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital Seoul, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon-Hee Choi
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital Seoul, Soonchunhyang University College of Medicine, Seoul, Republic of Korea,Correspondence to: Yoon-Hee Choi, Department of Physical Medicine and Rehabilitation, Soonchunhyang University Hospital Seoul, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul04401, Republic of Korea; Ph: 82-2-709-3240. ,
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Saarinen AJ, Bauer JM, Verhofste B, Sponseller PD, Krengel WF, Hedequist D, Cahill PJ, Larson AN, Pahys JM, Martus JE, Yaszay B, Phillips JH, Helenius IJ. Results of Conservative and Surgical Management in Children with Idiopathic and Nonidiopathic Os Odontoideum. World Neurosurg 2020; 147:e324-e333. [PMID: 33333287 DOI: 10.1016/j.wneu.2020.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The outcomes of conservative and operative treatment of os odontoideum in children remain unclear. Our objective was to study the outcomes of conservative and surgical treatment of idiopathic os odontoideum in children and compare these outcomes in age- and treatment-matched nonidiopathic children with os odontoideum. METHODS A retrospective multicenter review identified 102 children with os odontoideum, of whom 44 were idiopathic with minimum 2-year follow-up. Ten patients were treated conservatively, and 34 underwent spinal arthrodesis. Both groups were matched with nonidiopathic patients by age and type of treatment. Cervical arthrodesis was recommended for patients with increased atlantoaxial distance or reduced space available for the cord in flexion-extension radiographs. RESULTS All 20 children undergoing conservative treatment remained asymptomatic during follow-up, but 1 nonidiopathic patient developed cervical instability. The idiopathic group had significantly less severe radiographic cervical instability and less neurologic complications than the nonidiopathic group (P < 0.05 for all comparisons). Thirty-three (97%) patients in the idiopathic group and 32 (94%) patients in the nonidiopathic group (94%) had spinal fusion at final follow-up (P = 0.55). The risk of complications (15% vs. 41%; odds ratio 0.234, 95% confidence interval 0.072-0.757, P = 0.015) and nonunion (6% vs. 24%; odds ratio 0.203, 95% confidence interval 0.040-0.99, P = 0.040) were significantly lower in the idiopathic than in the nonidiopathic group. Idiopathic children undergoing rigid fixation achieved spinal fusion. CONCLUSIONS Idiopathic patients with stable atlantoaxial joint at presentation remained asymptomatic and intact during conservative treatment. Idiopathic children with os odontoideum undergoing spinal arthrodesis had significantly fewer complications and nonunion than nonidiopathic children. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Antti J Saarinen
- Department of Paediatric Orthopaedic Surgery, Turku University Hospital, Turku, Finland; Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland.
| | - Jennifer M Bauer
- Department of Orthopedics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Bram Verhofste
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Walter F Krengel
- Department of Orthopedics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Daniel Hedequist
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Patrick J Cahill
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Joshua M Pahys
- Department of Orthopaedic Surgery, Shiners Hospitals for Children, Philadelphia, Pennsylvania, USA
| | - Jeffrey E Martus
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt Children's Hospital, Nashville, Tennessee, USA
| | - Burt Yaszay
- Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Jonathan H Phillips
- Department of Pediatric Orthopedics, Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Ilkka J Helenius
- Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland
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Abstract
Os odontoideum is a rare entity of the second cervical vertebra, characterized by a circumferentially corticated ossicle separated from the body of C2. The ossicle is a distinct entity from an odontoid fracture or a persistent ossiculum terminale. The diagnosis may be made incidentally on imaging obtained for the workup of neck pain or neurologic signs and symptoms. Diagnosis usually can be made with plain radiographs. MRI and CT can assess spinal cord integrity and C1-C2 instability. The etiology of os odontoideum is a topic of debate, with investigative studies supporting both congenital and traumatic origins. A wide clinical range of symptoms exists. Symptoms may present as nondescript pain or include occipital-cervical pain, myelopathy, or vertebrobasilar ischemia. Asymptomatic cases without evidence of radiologic instability are typically managed with periodic observation and serial imaging. The presence of atlantoaxial instability or neurological dysfunction necessitates surgical intervention with instrumentation and fusion for stability.
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Affiliation(s)
- Daniel J Hedequist
- From the Department of Orthopaedic Surgery, Boston Children's Hospital/Harvard Medical School, Boston, MA (Dr. Hedequist), and the Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY (Dr. Mo)
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Pluemvitayaporn T, Kunakornsawat S, Piyaskulkaew C, Pruttikul P, Pongpinyopap W. Chronic posterior atlantoaxial subluxation associated with os odontoideum: a rare condition. A case report and literature review. Spinal Cord Ser Cases 2018; 4:110. [PMID: 30588336 PMCID: PMC6300540 DOI: 10.1038/s41394-018-0143-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 01/04/2023] Open
Abstract
Introduction Os odontoideum is a rare cervical lesion. This unusual condition is sometimes associated with atlantoaxial subluxation, which is mostly anterior subluxation. Posterior atlantoaxial subluxation due to os odontoideum is extremely rare. Case presentation We report an unusual case of a 60-year-old Thai female, who was diagnosed as having chronic posterior atlantoaxial subluxation associated with os odontoideum with progressive myelopathy. The patient underwent posterior arch of C1 laminectomy and an occipito-C3 fusion using an occipital plate, C2 pedicle screws, C3 lateral mass screws and autologous iliac crest strut bone graft arthrodesis. During three years of follow-up, she was clinically significantly improved and postoperative radiographs showed a solid osseous fusion without loss of correction or implant failure. Discussion Chronic posterior atlantoaxial subluxation associated with os odontoideum is rare. This condition can cause occipital-cervical pain, myelopathy, intracranial symptoms, or death. Surgical decompression and stabilization is the treatment of choice. Principles of treatment are to prevent sudden death from neurological compromise, improve neurological status, stabilize the cervical spine, and improve quality of life. Surgical options include atlantoaxial fusion, occipito-C2 fusion, and occipito-C3 fusion. Decision making depends on the location of spinal cord compression, area for arthrodesis, and bone quality.
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Klassov Y, Benkovich V, Kramer MM. Post-traumatic os odontoideum - case presentation and literature review. Trauma Case Rep 2018; 18:46-51. [PMID: 30533483 PMCID: PMC6263090 DOI: 10.1016/j.tcr.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2018] [Indexed: 11/25/2022] Open
Abstract
Os odontoideum is a rare condition. Nevertheless this condition was described by Giacomini in 1886. It is defined radiologicaly as an oval or round-shaped ossicle of variable size with smooth circumferential cortical margins representing the odontoid process that has no continuity with the body of C2. It is important to review this topic since the upper cervical spinal region is complex from anatomical point of view and has many vital structures passing in close relation to each other. If a person suffers from hyper mobile dens due to insufficiency of its ligamentous complex, it may cause translation of the atlas on the axis and may compress the cervical cord or vertebral arteries. There are cases where patients suffering from Os odontoideum became quadriplegic after a minor trauma. This lesion usually present in pediatric population and its cause is widely debatable today. In our paper we present a review of Os odontoideum in general and present a specific case of a young woman that was diagnosed with Os odontoideum together with the methods that were used to examine, stabilize and finally treat her.
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Affiliation(s)
- Yuri Klassov
- Soroka University Medical Center, Orthopedic Surgery Department, Beer-Sheva, Israel
- Corresponding author.
| | - Vadim Benkovich
- Soroka University Medical Center, Department of Joint Arthroplasty, Israel
- “Yonatan” Center-Israeli Joint and Spine Health Center, Assuta Medical Center, Israel
| | - M. Moti Kramer
- Soroka University Medical Center, Department of Spine Surgery, Beer-Sheva, Israel
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Rahimizadeh A, Williamson WL, Rahimizadeh S, Amirzadeh M. Atlantoaxial Subluxation Secondary to Unstable Os Odontoideum in a Patient With Arrested Hydrocephalus Due to Congenital Aqueductal Stenosis: A Case Report. Int J Spine Surg 2018; 12:549-556. [PMID: 30364750 PMCID: PMC6198626 DOI: 10.14444/5067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In a small percentage of children born with congenital hydrocephalus, enlargement of the head and the presence of ventriculomegaly may halt and ultimately stabilize the condition designated as arrested hydrocephalus. Arrested hydrocephalus in children is typically due to congenital aqueduct stenosis, which can be described appropriately as a stasis existing within the channel between the third and fourth ventricles. Os odontoideum (OO) is an uncommonly occurring pathology at the craniovertebral junction. Although the clinical and radiologic features of its existence and the therapeutic options for its pathology have been widely discussed within the medical literature, its true etiology has been a source of divisive debate, proposing both a traumatic as well as a congenital mechanism. The etiology of OO has been heartily debated in the literature for several years as well. Most authors have come to support a posttraumatic causality. However, strong evidence exists to support a congenital origin to this rarely observed malformation. METHODS Within this case study we present a 24-year-old woman with atlantoaxial subluxation that exists secondary to an orthotropic OO. The patient had a history of arrested hydrocephalus due to congenital aqueductal stenosis beginning in early childhood. She presented with normal intelligence and was neurologically without deficits before the occurrence of an atlantoaxial dislocation. Unfortunately, the pathology was initially misdiagnosed as a decompensation state of the arrested hydrocephalus, and after 8 months the patient became wheelchair bound. Following this unfortunate event the correct diagnosis was ultimately uncovered. Subsequently a C2-1 instrumentation procedure resulted in excellent alignment and fusion. CONCLUSIONS To the best of our knowledge, this is the first example of an aqueduct stenosis in the setting of an existing OO, a combination that might be another clue in favor of a congenital etiology.
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Affiliation(s)
- Abolfazl Rahimizadeh
- Department of Spinal Surgery, Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Tehran, Iran
| | | | | | - Mahan Amirzadeh
- Department of Spinal Surgery, Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Tehran, Iran
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Pavlova OM, Ryabykh SO, Burcev AV, Gubin AV. Anomaly-Related Pathologic Atlantoaxial Displacement in Pediatric Patients. World Neurosurg 2018; 114:e532-e545. [DOI: 10.1016/j.wneu.2018.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 11/30/2022]
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Tejada Meza H, Modrego Pardo P, Gazulla Abio J. Cervical myelopathy as the initial manifestation of os odontoideum. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2014.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Atlantoaxial Subluxation due to an Os Odontoideum in an Achondroplastic Adult: Report of a Case and Review of the Literature. Case Rep Orthop 2015; 2015:142586. [PMID: 26693369 PMCID: PMC4674663 DOI: 10.1155/2015/142586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 10/25/2015] [Indexed: 11/17/2022] Open
Abstract
The authors report the first example of an adult achondroplastic dwarf with progressive quadriparesis secondary to atlantoaxial subluxation as a consequence of an os odontoideum. Actually, craniocervical region is a frequent site of compression and myelopathy in achondroplasia particularly in children as a result of small foramen magnum and hypertrophied opisthion. Moreover, very rarely in achondroplastic patients, coexistence of atlantoaxial instability as the sequel of os odontoideum can result in further compression of the already compromised cervicomedullary neural tissues, the scenario that has been reported only in five achondroplastic children. Herein, a 39-year-old achondroplastic male suffering such an extremely rare combination is presented. With C1-C2 screw rod instrumentation, atlas arch laminectomy, limited suboccipital craniectomy, and release of dural fibrous bands, reduction, decompression, and stabilization could be achieved properly resulting in steady but progressive recovery.
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10
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Zhao D, Wang S, Passias PG, Wang C. Craniocervical instability in the setting of os odontoideum: assessment of cause, presentation, and surgical outcomes in a series of 279 cases. Neurosurgery 2015; 76:514-21. [PMID: 25635883 DOI: 10.1227/neu.0000000000000668] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Our clinical understanding of os odontoideum (OO) remains incomplete. Congenital and traumatic causes have been proposed and advocated. Clinical presentations range from asymptomatic to axial pain to myelopathy or vertebral-basilar ischemia. A consensus for surgical management exists for those found to have an unstable atlantoaxial complex or symptomatic cranial-vertebral junction compression. OBJECTIVE To evaluate the clinical presentation and surgical outcomes of patients with OO and an unstable atlantoaxial complex or symptomatic cranial-vertebral junction compression. METHODS Patients with a diagnosis of OO who underwent surgical management were included. Patients were excluded on the basis of previous C2 fracture, Fielding diagnostic criteria, and inadequate follow-up. History of trauma and presenting symptoms were assessed. Clinical and neurological improvements were measured with the use of patient satisfaction scores and the Japanese Orthopaedic Association scores. Fusion status was documented with the use of radiographs and computed tomographic imaging. RESULTS Of 279 patients, 112 reported a history of cranial-vertebral junction trauma, whereas 28 were diagnosed with congenital malformations. Clinically, 84.9% of patients presented with myelopathy, with pain presented in 42.6%. Atlantoaxial fixation was performed in 240 patients, occiput-to-C2 fixation in 35 patients, and extended occipito-cervical fixation in 4 patients. Mean follow-up was 40.3 months. Complications were reported in 2.4% of patients. Japanese Orthopaedic Association scores improved from a preoperative mean of 12.4 to 14.8. Two hundred thirty-five patients (77.7%) improved, with 30 patients experiencing no change in symptoms and 14 patients deteriorating. Fusion was achieved in 96.8% of patients. CONCLUSION Our data reveal that surgical treatment for OO using the indications and techniques delineated is associated with high satisfaction rates, improved functional scores, and high fusion rates with low complication rates.
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Affiliation(s)
- Deng Zhao
- *Orthopaedic Department, Peking University Third Hospital, Beijing, China; ‡Orthopaedic Department, Third People's Hospital of Chengdu/Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, China; §Division of Spinal Surgery, NYU Medical Center/Hospital for Joint Diseases, NYU School of Medicine, New York, New York
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11
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Rhea PRR, Ronald PT, James AS, Paul GLE. Occipito-thoracic fusion in incidental dystropic os odontoideum in a patient suspected with osteogenesis imperfecta: A case report. ACTA MEDICA INTERNATIONAL 2015. [DOI: 10.5530/ami.2015.1.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Tejada Meza H, Modrego Pardo P, Gazulla Abio J. [Cervical myelopathy as the initial manifestation of os odontoideum]. Neurologia 2014; 31:278-9. [PMID: 25150883 DOI: 10.1016/j.nrl.2014.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/23/2014] [Accepted: 06/29/2014] [Indexed: 11/17/2022] Open
Affiliation(s)
- H Tejada Meza
- Departamento de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - P Modrego Pardo
- Departamento de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Gazulla Abio
- Departamento de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
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Straus D, Xu S, Traynelis VC. Os odontoideum in identical twins: Comparative gene expression analysis. Surg Neurol Int 2014; 5:37. [PMID: 24818044 PMCID: PMC4014826 DOI: 10.4103/2152-7806.129259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 02/06/2014] [Indexed: 12/02/2022] Open
Abstract
Background: Os odontoideum is a well identified anomaly of the craniovertebral junction. Since its initial description, there has been a continuous debate regarding the nature of its etiology: Whether congenital or traumatic. We sought to compare the gene expression profiles in patients with congenital os odontoideum, those with traumatic os odontoideum and controls. Methods: We have evaluated a pair of identical twins both with os odontoideum. We identified two additional patients with and four subjects without os odontoideum. We analyzed the gene expression profiles in these patients using a custom TaqMan microarray and quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). The relative gene expression profiles in the two identical twins, the two nontwin patients with os odontoideum and the controls were assessed. Results: A total of 213 genes with significantly different expression between the twin os odontoideum patients and the subjects without os odontoideum were detected. CACNG6, PHEX, CACNAD3, IL2, FAS, TUFT1, KIT, TGFBR2, and IGF2 were expressed at levels greater than 100-fold more in the twins. There were six genes with significantly different expression profiles in the twins as compared with the nontwin os odontoideum patients: CMK4, ATF1, PLCG1, TAB1, E2F3, and ATF4. There were no statistically significant differences in gene expression in the four patients with os odontoideum and the subjects without. Trends, however, were noted in MMP8, KIT, HIF1A, CREB3, PWHAZ, TGFBR1, NFKB2, FGFR1, IPO8, STAT1, COL1A1, and BMP3. Conclusions: Os odontoideum has multiple etiologies, both traumatic and congenital and perhaps some represent a combination of the two. This work has identified a number of genes that show increased expression in a pair of twins with congenital os odontoideum and also demonstrates trends in gene expression profiles between a larger group of os odontoideum patients and non-os patients. A number of these genes are related to bone morphogenesis and maintenance.
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Affiliation(s)
- David Straus
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shunbin Xu
- Department of Pharmacology, Ophthalmology and Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Vincent C Traynelis
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
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Mick TJ. Congenital Diseases. Clin Imaging 2014. [DOI: 10.1016/b978-0-323-08495-6.00008-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rozzelle CJ, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Ryken TC, Theodore N, Walters BC, Hadley MN. Os odontoideum. Neurosurgery 2013; 72 Suppl 2:159-69. [PMID: 23417188 DOI: 10.1227/neu.0b013e318276ee69] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Curtis J Rozzelle
- Division of Neurological Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, AL 35294, USA
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Choi SH, Lee SG, Park CW, Kim WK, Yoo CJ, Son S. Surgical outcomes and complications after occipito-cervical fusion using the screw-rod system in craniocervical instability. J Korean Neurosurg Soc 2013; 53:223-7. [PMID: 23826478 PMCID: PMC3698232 DOI: 10.3340/jkns.2013.53.4.223] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/12/2013] [Accepted: 04/08/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Although there is no consensus on the ideal treatment of the craniocervical instability, biomechanical stabilization and bone fusion can be induced through occipito-cervical fusion (OCF). The authors conducted this study to evaluate efficacy of OCF, as well as to explore methods in reducing complications. METHODS A total of 16 cases with craniocervical instability underwent OCF since the year 2002. The mean age of the patients was 51.5 years with a mean follow-up period of 34.9 months. The subjects were compared using lateral X-ray taken before the operation, after the operation, and during last follow-up. The Nurick score was used to assess neurological function pre and postoperatively. RESULTS All patients showed improvements in myelopathic symptoms after the operation. The mean preoperative Nurick score was 3.1. At the end of follow-up after surgery, the mean Nurick score was 2.0. After surgery, most patients' posterior occipito-cervical angle entered the normal range as the pre operation angle decresed from 121 to 114 degree. There were three cases with complications, such as, vertebral artery injury, occipital screw failure and wound infection. In two cases with cerebral palsy, occipital screw failures occurred. But, reoperation was performed in one case. CONCLUSION OCF is an effective method in treating craniocervical instability. However, the complication rate can be quite high when performing OCF in patients with cerebral palsy, rheumatoid arthritis. Much precaution should be taken when performing this procedure on high risk patients.
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Affiliation(s)
- Sung Ho Choi
- Department of Neurosurgery, Gachon University, Gil Hospital, Incheon, Korea
| | - Sang Gu Lee
- Department of Neurosurgery, Gachon University, Gil Hospital, Incheon, Korea
| | - Chan Woo Park
- Department of Neurosurgery, Gachon University, Gil Hospital, Incheon, Korea
| | - Woo Kyung Kim
- Department of Neurosurgery, Gachon University, Gil Hospital, Incheon, Korea
| | - Chan Jong Yoo
- Department of Neurosurgery, Gachon University, Gil Hospital, Incheon, Korea
| | - Seong Son
- Department of Neurosurgery, Gachon University, Gil Hospital, Incheon, Korea
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A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21:1580-9. [PMID: 22547213 DOI: 10.1007/s00586-012-2324-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 02/22/2012] [Accepted: 04/14/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the effectiveness of posterior occipitocervical reconstruction using the anchors of cervical pedicle screws and plate-rod systems for patients with congenital osseous anomalies at the craniocervical junction. METHODS Twenty patients with congenital osseous lesions who underwent posterior occipitocervical fusion using the anchors of cervical pedicle screws and plate-rod systems for reduction and fixation from 1996 to 2009 were reviewed. The lesions included os odontoideum, occipitalization of the atlas, congenital C2-3 fusion, congenital atlantoaxial subluxation, congenital basilar invagination and combined anomalies. The clinical assessment and the measurements of the images were performed preoperatively, postoperatively and at most recent follow-up. RESULTS The combined deformity of flexion of the occipitoatlantoaxial complex and invagination of the odontoid process associated with congenital osseous lesions at the craniocervical junction was corrected by application of combined forces of extension and distraction between the occiput and the cervical pedicle screws. Preoperative myelopathy improved in 94.7% patients. The mean Ranawat value, Redlund-Johnnell value, atlantodental distance, occiput (O)-C2 angle, and C2-C7 lordosis angle improved postoperatively and was sustained at most recent follow-up. The mean cervicomedullary angle improved from 129.3° preoperatively to 153.3° postoperatively. The mean range of motion at the lower adjacent motion segment remained unchanged at most recent follow-up. The fusion rate was 95%. CONCLUSIONS The results of the present study indicate that posterior occipitocervical reconstruction using the anchors of cervical pedicle screws and plate-rod systems is an effective technique for treatment of deformities and/or instability caused by congenital osseous anomalies at the craniocervical junction.
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Abstract
Encephalocele means if meninges and brain tissue protrude out of the cranium. There are different types of encephalocele. The occipital encephaloceles are the most common type. Craniocervical junction and upper cervical spine abnormalities can rarely be associated with occipital encephalocele. We discuss this case because there is rare association between torcular encephalocele and proatlas anomalies.
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Affiliation(s)
- Haradhan Deb Nath
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka, Bangladesh
| | - Ashok Kumar Mahapatra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Gunawat
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Surgical treatment of chronic C1-C2 dislocation with absence of odontoid process using C1 hooks with C2 pedicle screws: a case report and review of literature. Spine (Phila Pa 1976) 2011; 36:E1245-9. [PMID: 21358484 DOI: 10.1097/brs.0b013e318205620a] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report. OBJECTIVE.: A rare case of chronic C1-C2 dislocation with absence of odontoid process that underwent posterior C1-C2 arthrodesis using C1 hooks and C2 pedicle screws. SUMMARY OF BACKGROUND DATA C1-C2 dislocation is a rare but fatal upper cervical injury. To date, there have been many reports about C1-C2 dislocation of traumatic origin. However, very few C1-C2 dislocation cases of congenital odontoid deformities had been presented. This was particularly the case when the odontoid process was absent. METHODS Plain radiograph of his cervical spine revealed a C1-C2 dislocation, and subsequent computed tomographic scan as well as magnetic resonance imaging (MRI) detected absence of odontoid process and cord compression. Upon admission, the patient was placed on skull traction and the weight increased from 3.5 to 5.5 kg. After 10 days of traction, reduction was achieved radiographically and the posterior C1-C2 arthrodesis by C1 hooks with C2 pedicle screws was performed. RESULTS After surgery, the patient showed significant improvement in gait function despite slightly raised muscle tone in his lower extremities. Four-month postoperative radiographs indicated restoration of C1-C2 alignment and bony fusion. No residual cord compression was present. CONCLUSION In clinical evaluation of patients who present with neck pain and limited cervical motion with or without neurologic deficits, C1-C2 dislocation should be considered. If the patient has no history of trauma or infection, congenital C1-C2 deformity, especially odontoid malformation, has to be included as a possible factor. Once the diagnosis is confirmed, posterior C1-C2 arthrodesis may become necessary for stabilizing C1-C2 and preventing it from deterioration or new development of neurologic symptoms.
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Kim IS, Hong JT, Jang WY, Yang SH, Sung JH, Son BC, Lee SW. Surgical treatment of os odontoideum. J Clin Neurosci 2011; 18:481-4. [PMID: 21256752 DOI: 10.1016/j.jocn.2010.07.114] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 06/23/2010] [Accepted: 07/04/2010] [Indexed: 11/30/2022]
Abstract
Os odontoideum is a rare disease. There have been few reports of os odontoideum in the literature. In this study we retrospectively reviewed eight surgically treated patients. One patient underwent C1-2 transarticular screw fixation, five patients underwent C1-2 polyaxial screw and rod fixation and two patients with dystopic os odontoideum underwent occipito-cervical (O-C) fusion. Of the eight patients, neck pain was alleviated in seven (87.5%). Of the six patients who had neurological signs and symptoms, five (83.3%) exhibited neurological improvement. Radiologically, solid fusion was observed in seven patients (87.5%). Active surgical treatment should be considered even in patients with os odontoideum who exhibit mild symptoms. In most patients with os odontoideum, use of the C1-2 polyaxial screw and rod technique may be the most appropriate treatment. In patients with dystopic os odontoideum, O-C fusion should be considered.
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Affiliation(s)
- Il Sup Kim
- Department of Neurosurgery, St Vincent's Hospital, The Catholic University of Korea, 93-6 Ji-dong, Paldal-ku, Suwon, Gyonggi-do 442-723, Republic of Korea
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El Asri AC, Akhaddar A, Gazzaz M, Okacha N, Boulhroud O, Baallal H, Belfquih H, Belhachmi A, Mandour C, El Mostarchid B, Boucetta M. Dynamic CT scan of the craniovertebral junction: a role in the management of os odontoideum. Neurol Neurochir Pol 2010; 44:603-8. [PMID: 21225524 DOI: 10.1016/s0028-3843(14)60159-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Os odontoideum is an uncommon abnormality of the cranio-vertebral junction (CVJ) that exists as a separate ossicle apart from a hypoplastic dens. Its genesis and natural history have been debated, and its proper treatment remains uncertain. A 48-year-old woman complained of persistent upper neck pain and paraesthesia of her left side. Magnetic resonance imaging of the CVJ demonstrated an os odontoideum. Dynamic computed tomography scan of the CVJ showed a reduction of the space available for the spinal cord to 50% from extended to flexed position. The patient underwent posterior spinal fusion of C1-C2 using a sublaminar titanium hook and rods fixed in moderate extension. We discuss the usefulness of the dynamic computed tomography (CT) scan in the evaluation of atlantoaxial motion and the management of this pathology.
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Arvin B, Fournier-Gosselin MP, Fehlings MG. Os odontoideum: etiology and surgical management. Neurosurgery 2010; 66:22-31. [PMID: 20173524 DOI: 10.1227/01.neu.0000366113.15248.07] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Os odontoideum is an independent ossicle of variable size with smooth circumferential cortical margins separated from the foreshortened odontoid peg. The etiology of os odontoideum remains controversial, but there is now emerging consensus on the traumatic etiology of os odontoideum rather than a congenital source. RESULTS We reviewed the literature of os odontoideum. Patients with this condition can be asymptomatic or present with wide range of neurological dysfunctions. Although the diagnosis of os odontoideum can be made with plain x-rays, further imaging modalities including magnetic resonance imaging and computed tomography angiography have improved the preoperative planning. CONCLUSION There is a role for conservative treatment of an asymptomatic incidentally found, radiologically stable, and noncompressive os odontoideum. Conversely, surgery has a definite role in symptomatic cases. The main method of surgical treatment today is posterior decompression after reduction and fusion via independent C1 and C2 instrumentation. Irreducible, persistent anterior compression from os odontoideum can be approached by a transoral route with good results in experienced hands.
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Affiliation(s)
- Babak Arvin
- Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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Klimo P, Kan P, Rao G, Apfelbaum R, Brockmeyer D. Os odontoideum: presentation, diagnosis, and treatment in a series of 78 patients. J Neurosurg Spine 2008; 9:332-42. [PMID: 18939918 DOI: 10.3171/spi.2008.9.10.332] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The most contentious issue in the management of os odontoideum surrounds the decision to attempt atlantoaxial fusion in patients with asymptomatic lesions. The authors examined the clinical presentation and outcome in patients with os odontoideum who underwent surgical stabilization, with an emphasis on 3 patients who initially received conservative treatment and suffered delayed neurological injury. METHODS Seventy-eight patients (mean age 20.5 years; median 15 years) were identified in a 17-year retrospective review. The median follow-up period was 14 months (range 1-115 months). Neck pain was the most common symptom (64%), and 56% of patients presented after traumatic injury. Eighteen patients had neurological signs or symptoms at presentation, and an additional 15 had a history of intermittent or prior neurological symptoms. Fifteen patients had undergone > or = 1 attempt at atlantoaxial fusion elsewhere. RESULTS Seventy-seven patients underwent posterior fusion and rigid screw fixation combined with a graft/wire construct: 75 had C1-2 fusion and 2 had occipitocervical fusion. One patient had an odontoid screw placed. Fusion was achieved in all patients at a median of 4.8 months (range 2-17 months). Approximately 90% of patients had resolution or improvement of their neck pain or neurological symptoms. CONCLUSIONS The authors believe that patients with os odontoideum are at risk for future spinal cord compromise. Forty-four percent of our patients had myelopathic symptoms at referral, and 3 had significant neurological deterioration when a known os odontoideum was left untreated. This risk of late neurological deterioration should be considered when counseling patients. Stabilization using internal screw fixation techniques resulted in 100% fusion, whereas 15% of patients had previously undergone unsuccessful wire and external bracing attempts.
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Affiliation(s)
- Paul Klimo
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84132, USA
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Bibliography. Neurosurgery 2002. [DOI: 10.1097/00006123-200203001-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
DIAGNOSIS STANDARDS There is insufficient evidence to support diagnostic standards. GUIDELINES There is insufficient evidence to support diagnostic guidelines. OPTIONS Plain x-rays of the cervical spine (anteroposterior, open-mouth odontoid, and lateral) and plain dynamic lateral x-rays performed in flexion and extension are recommended. Tomography (computed or plain) and/or magnetic resonance imaging of the craniocervical junction may be considered. MANAGEMENT STANDARDS There is insufficient evidence to support treatment standards. GUIDELINES There is insufficient evidence to support treatment guidelines. OPTIONS Patients with os odontoideum, either with or without C1--C2 instability, who have neither symptoms nor neurological signs may be managed with clinical and radiographic surveillance. Patients with os odontoideum, particularly with neurological symptoms and/or signs, and C1--C2 instability may be managed with posterior C1--C2 internal fixation and fusion. Postoperative halo immobilization as an adjunct to posterior internal fixation and fusion is recommended unless successful C1--C2 transarticular screw fixation and fusion can be accomplished. Occipitocervical fusion with or without C1 laminectomy may be considered in patients with os odontoideum who have irreducible cervicomedullary compression and/or evidence of associated occipitoatlantal instability. Transoral decompression may be considered in patients with os odontoideum who have irreducible ventral cervicomedullary compression.
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