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Finkel RA, Narendran N, Nilssen PK, Skaggs DL, Illingworth KD. Vertebral Artery Dissection in the Setting of Unstable Os Odontoideum: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00054. [PMID: 38134303 DOI: 10.2106/jbjs.cc.23.00466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
CASE A healthy 5-year-old boy presented with a gradual onset of headaches and acute global right-sided weakness over 10 days. The work-up revealed unstable os odontoideum leading to multiple posterior circulation infarcts with vertebral artery dissection. He underwent antiplatelet therapy, cervical collar immobilization, and delayed occiput to C2 posterior spinal fusion and instrumentation with iliac crest autograft. At 2-year follow-up, the patient had a solid fusion mass, appropriate cervical alignment, and was without neurologic sequelae. CONCLUSION This case adds to a sparse body of literature in the management of vertebral artery dissection with vertebrobasilar insufficiency secondary to unstable os odontoideum.
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Affiliation(s)
- Ryan A Finkel
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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2
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Dahdaleh N, Cho S, Shlobin N. Os odontoideum: A comprehensive review. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:256-264. [PMID: 36263339 PMCID: PMC9574117 DOI: 10.4103/jcvjs.jcvjs_71_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/31/2022] [Indexed: 11/10/2022] Open
Abstract
Os odontoideum (OO) is a rare craniocervical anomaly that is characterized by a round ossicle separated from the C2 vertebral body. With a controversial etiology and unknown prevalence in the population, OO may be asymptomatic or present in patients with myelopathic and neurological symptoms. In this literature review, we aimed to investigate epidemiology, embryology, pathophysiology, clinical presentation, and the role of diagnostic radiography in OO. By providing an overview of different management strategies, surgical complications, and postoperative considerations for OO, our findings may guide neurosurgeons in providing proper diagnosis and treatment for OO patients. A literature review was conducted using the PubMed, EMBASE, and Scopus databases. A search using the query “os odontoideum” yielded 4319 results, of which 112 articles were chosen and analyzed for insights on factors such as etiology, clinical presentation, and management of OO. The presentation of OO varies widely from asymptomatic cases to severe neurological deficits. Asymptomatic patients can be managed either conservatively or surgically, while symptomatic patients should undergo operative stabilization. Although multiple studies show different techniques for surgical management involving posterior fusion, the diversity of such cases illustrates how treatment must be tailored to the individual patient to prevent complications. Conflicting studies and the paucity of current literature on OO highlight poor comprehension of the condition. Further understanding of the natural history of OO is critical to form evidence-based guidelines for the management of OO patients. More large-center studies are thus needed to promote accurate management of OO patients with optimal outcomes.
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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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Dhawale A, Bajaj S, Chaudhary K, Agarwal T, Garg S, Choudhury H. Posterior Circulation Stroke due to Atlantoaxial Instability in CHST3-Related Skeletal Dysplasia: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00034. [PMID: 33625031 DOI: 10.2106/jbjs.cc.20.00393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE An eight-year-old boy presented with acute encephalopathy due to posterior circulation ischemic stroke. He was found to have vertebral artery stenosis secondary to atlantoaxial instability (AAI) due to an os odontoideum. Occipitocervical fusion was performed 4 weeks after stroke. The child improved neurologically and regained independent ambulation. He had indications of an underlying spondyloepiphyseal dysplasia with joint luxation and whole-exome sequencing diagnosed CHST3-related skeletal dysplasia. CONCLUSION As far as we know, this AAI due to an os odontoideum is a previously unreported complication of CHST3-related skeletal dysplasia. Occipitocervical fusion yielded good clinical results with the 1-year follow-up.
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Affiliation(s)
- Arjun Dhawale
- Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Shruti Bajaj
- Department of Pediatrics, Sir H.N. Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Kshitij Chaudhary
- Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Tushar Agarwal
- Department of Orthopaedics, Bhaktivedanta Hospital and Research Institute, Thane, Maharashtra, India
| | - Sandeep Garg
- Department of Pediatrics, Bhaktivedanta Hospital and Research Institute, Thane, Maharashtra, India
| | - Himanshu Choudhury
- Department of Radiology, Sir H.N. Reliance Foundation Hospital, Mumbai, Maharashtra, India
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Kim HG, Choi HY, Park JS, Ryu KN, Park SY, Jin W. Clinical Features and Radiological Differential Diagnoses of Symptomatic Sesamoid Bones and Accessory Ossicles: A Pictorial Essay. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:82-98. [PMID: 36237464 PMCID: PMC9432401 DOI: 10.3348/jksr.2020.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/23/2020] [Accepted: 07/03/2020] [Indexed: 11/17/2022]
Abstract
종자골과 부골은 정상 해부학적 변이로 그 빈도와 형태는 다양하며 일반적으로 크기가 작고 둥근 모양으로 피질로 잘 둘러싸여 있고 뼈나 관절 주위에 인접하여 관찰되고 드물게 이분 혹은 다분 형태를 보일 수 있다. 대부분의 종자골과 부골은 무증상이며 판독 업무 중에 흔히 마주치게 된다. 하지만 때때로 종자골과 부골이 증상을 일으킬 수 있는데, 종자골과 부골 자체의 골절이나 탈구, 관절염, 골괴사, 감염 등의 질환이 이환되거나, 주변에 신경압박이나 건초염, 연부조직의 포착 등에 의하여 증상을 유발할 수 있다. 이 종설에서는 다양한 해부학적 위치에서 발생한 증상이 있는 종자골과 부골의 영상을 보고, 이들의 임상적 양상과 영상의학적 감별진단을 정리해보고자 한다.
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Affiliation(s)
- Hyun Gun Kim
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hee Young Choi
- Department of Radiology, DongSuWon General Hospital, Suwon, Korea
| | - Ji Seon Park
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
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Fox CK, Fullerton HJ, Hetts SW, Halbach VV, Auguste KI, Lawton MT, Gupta N. Single-center series of boys with recurrent strokes and rotational vertebral arteriopathy. Neurology 2020; 95:e1830-e1834. [PMID: 32690796 DOI: 10.1212/wnl.0000000000010416] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/07/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe a pediatric stroke syndrome with chronic focal vertebral arteriopathy adjacent to cervical abnormalities. METHODS At a single pediatric stroke center, we identified consecutive children with stroke and vertebral arteriopathy of the V3 segment with adjacent cervical bony or soft tissue abnormalities. We abstracted clinical presentation, treatment, and follow-up data from medical charts. RESULTS From 2005 to 2019, 10 children (all boys, ages 6-16 years) presented with posterior circulation strokes and vertebral arteriopathy with adjacent cervical pathology. Two children had bony abnormalities: one had a congenital arcuate foramen and one had os odontoideum with cervical instability. In children without bony pathology, vertebral artery narrowing during contralateral head rotation was visualized by digital subtraction angiography. Eight boys had recurrent ischemic events despite anti-thrombotic treatment (including 5 with multiple recurrences) and were treated surgically to prevent additional stroke. Procedures included vertebral artery decompression (n = 6), endovascular stent and spinal fusion (n = 1), and vertebral artery endovascular occlusion (n = 1). In boys treated with decompression, cervical soft tissue abnormalities (ruptured atlantoaxial bursa, ruptured joint capsule, or connective tissue scarring) were directly visualized during open surgery. No other etiology for stroke or dissection was found in any of the cases. Two boys without recurrent stroke were treated with activity restriction and antithrombotics. At a median follow-up of 51 months (range 17-84), there have been no additional recurrences. CONCLUSIONS Children with V3 segmental vertebral arteriopathy frequently have stroke recurrence despite antithrombotics. Cervical bone imaging and angiography with neck rotation can identify underlying pathology.
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Affiliation(s)
- Christine K Fox
- From the Departments of Neurology (C.K.F., H.J.F.), Pediatrics (C.K.F., H.J.F., K.I.A., N.G.), Radiology and Biomedical Imaging (S.W.H., V.V.H.), and Neurological Surgery (K.I.A., M.T.L., N.G.), University of California San Francisco; and Department of Neurological Surgery (M.T.L.), Barrow Neurological Institute, Phoenix, AZ.
| | - Heather J Fullerton
- From the Departments of Neurology (C.K.F., H.J.F.), Pediatrics (C.K.F., H.J.F., K.I.A., N.G.), Radiology and Biomedical Imaging (S.W.H., V.V.H.), and Neurological Surgery (K.I.A., M.T.L., N.G.), University of California San Francisco; and Department of Neurological Surgery (M.T.L.), Barrow Neurological Institute, Phoenix, AZ
| | - Steven W Hetts
- From the Departments of Neurology (C.K.F., H.J.F.), Pediatrics (C.K.F., H.J.F., K.I.A., N.G.), Radiology and Biomedical Imaging (S.W.H., V.V.H.), and Neurological Surgery (K.I.A., M.T.L., N.G.), University of California San Francisco; and Department of Neurological Surgery (M.T.L.), Barrow Neurological Institute, Phoenix, AZ
| | - Van V Halbach
- From the Departments of Neurology (C.K.F., H.J.F.), Pediatrics (C.K.F., H.J.F., K.I.A., N.G.), Radiology and Biomedical Imaging (S.W.H., V.V.H.), and Neurological Surgery (K.I.A., M.T.L., N.G.), University of California San Francisco; and Department of Neurological Surgery (M.T.L.), Barrow Neurological Institute, Phoenix, AZ
| | - Kurtis I Auguste
- From the Departments of Neurology (C.K.F., H.J.F.), Pediatrics (C.K.F., H.J.F., K.I.A., N.G.), Radiology and Biomedical Imaging (S.W.H., V.V.H.), and Neurological Surgery (K.I.A., M.T.L., N.G.), University of California San Francisco; and Department of Neurological Surgery (M.T.L.), Barrow Neurological Institute, Phoenix, AZ
| | - Michael T Lawton
- From the Departments of Neurology (C.K.F., H.J.F.), Pediatrics (C.K.F., H.J.F., K.I.A., N.G.), Radiology and Biomedical Imaging (S.W.H., V.V.H.), and Neurological Surgery (K.I.A., M.T.L., N.G.), University of California San Francisco; and Department of Neurological Surgery (M.T.L.), Barrow Neurological Institute, Phoenix, AZ
| | - Nalin Gupta
- From the Departments of Neurology (C.K.F., H.J.F.), Pediatrics (C.K.F., H.J.F., K.I.A., N.G.), Radiology and Biomedical Imaging (S.W.H., V.V.H.), and Neurological Surgery (K.I.A., M.T.L., N.G.), University of California San Francisco; and Department of Neurological Surgery (M.T.L.), Barrow Neurological Institute, Phoenix, AZ
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7
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Xue S, Yang Y, Li P, Liu P, Du X, Ma X. Profiles of Vertebral Artery Dissection with Congenital Craniovertebral Junction Malformation: Four New Cases and a Literature Review. Neuropsychiatr Dis Treat 2020; 16:2429-2447. [PMID: 33116542 PMCID: PMC7588302 DOI: 10.2147/ndt.s262078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Vertebral artery dissection (VAD) combined with congenital craniovertebral junction malformation (CVJM) is rare. This study aimed to analyze the etiology, clinical and imaging features, treatment, and prognosis of VAD with CVJM. METHODS Four new cases of VAD with congenital CVJM and 28 similar cases found in the literature were included. Detailed clinical data from all cases were retrospectively analyzed. RESULTS A total of 32 patients (28 men, four women; mean age 19.01±12.53 years) were included. Seventeen of 32 cases (53.1%) had had multiple ischemic episodes. The most common neurological symptoms were limb numbness/weakness (20/32), ataxia (15/32), and dizziness/vertigo (12/32). In sum, 31 of 32 cases had multiple infarcts scattered throughout the posterior circulation area on cranial computed tomography or resonance imaging. Dissection had occurred in the V3 segment of the VA in 29/31 cases (93.5%). The most common congenital CVJMs were atlantoaxial dislocation and atlantoaxial subluxation (found in 20/32 cases [62.5%]), while 27/32 cases (84.3%) had multiple combined abnormalities. Seven of eleven cases (63.6%) with initial antiplatelet treatment and one of eleven (9.1%) with initial anticoagulation treatment experienced stoke recurrence. Fusion or vertebral fixation was performed in 16 patients and aneurysm resection in one patient. There was no reported recurrence after surgery in 13 patients with follow-up data. CONCLUSION Underlying CVJM is a rare but overlooked etiology in VAD, and is prone to induce recurrent ischemic stroke. Patients with VAD, especially that localized in the V3 segment, should be examined for CVJM. Timely assessment is critical for determining the specific cause and to provide targeted intervention.
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Affiliation(s)
- Sufang Xue
- Neurology Department of Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yi Yang
- Neurology Department of Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Pengyu Li
- Radiology Department of Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ping Liu
- Neurology Department of Hejian People's Hospital, Cangzhou, Hebei, People's Republic of China
| | - Xiangying Du
- Radiology Department of Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xin Ma
- Neurology Department of Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
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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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Jumah F, Alkhdour S, Mansour S, He P, Hroub A, Adeeb N, Hanif R, Mortazavi MM, Tubbs RS, Nanda A. Os Odontoideum: A Comprehensive Clinical and Surgical Review. Cureus 2017; 9:e1551. [PMID: 29018648 PMCID: PMC5630463 DOI: 10.7759/cureus.1551] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Os odontoideum (OO) is a rare anomaly of the odontoid process first described by Giacomini in 1886. There is considerable debate about the origin of this anomaly, whether congenital or acquired, though a growing body of evidence favors the latter. Using PubMed, we reviewed the literature on OO with regards to its etiology, clinical presentations, diagnostic modalities, and management. Manuscripts cited in reviews were also searched manually. Because the medical literature on this condition is limited, our understanding of the natural history and management of OO is still vague. The management guidelines for asymptomatic OO are preliminary. Therefore, we need more large-center studies to investigate this condition further.
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Affiliation(s)
- Fareed Jumah
- School of Medicine, An-najah National University Hospital, Nablus, Palestine
| | - Saja Alkhdour
- School of Medicine, An-najah National University Hospital, Nablus, Palestine
| | - Shaden Mansour
- School of Medicine, An-najah National University Hospital, Nablus, Palestine
| | - Puhan He
- Harvard School of Dental Medicine, Harvard University
| | - Ali Hroub
- School of Medicine, An-najah National University Hospital, Nablus, Palestine
| | - Nimer Adeeb
- Department of Neurosurgery, Louisiana State University, Shreveport, LA
| | - Rimal Hanif
- Department of Neurosurgery, Louisiana State University, Shreveport, LA
| | - Martin M Mortazavi
- California Institute of Neuroscience, Los Robles Hospital and Medical Center
| | | | - Anil Nanda
- Department of Neurosurgery, Louisiana State University, Shreveport, LA
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Titelbaum AR, Castillo SU. A rare case of os odontoideum from an Early Intermediate period tomb at the Huacas de Moche, Peru. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2015; 11:23-29. [PMID: 28802964 DOI: 10.1016/j.ijpp.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 08/08/2015] [Accepted: 08/14/2015] [Indexed: 06/07/2023]
Abstract
Os odontoideum is an uncommon vertebral anomaly where there is a smoothly corticated ossicle independent from a shortened odontoid peg. An example of os odontoideum was observed in an Early Intermediate period skeleton excavated from the Huacas de Moche (Moche IV, AD 400-700), Peru. The affected individual is a middle adult male who presents additional minor developmental anomalies of the axial skeleton. This individual was interred with a middle adult female who also has developmental anomalies of the axial skeleton, including block cervical vertebra (Klippel-Feil). Os odontoideum is infrequently reported in the medical literature and there continues to be debate about whether it is acquired or congenital. Unlike clinical cases, archaeological cases present an opportunity to examine the entirety of the skeleton. In the present case, there does not appear to be macroscopic or radiographic evidence for a healed fracture, and since the individual has multiple minor axial developmental anomalies, a congenital etiology is plausible. This case is the first to be described from the archaeological context of South America and one of few paleopathological examples worldwide.
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Affiliation(s)
- A R Titelbaum
- Basic Medical Sciences, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004, USA.
| | - S Uceda Castillo
- Proyecto Arqueológico Huacas del Sol y la Luna, Museo de Arqueología, Jr. Junin 682 Trujillo, Peru.
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11
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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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12
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Kulkarni GB, Mustare V, Pruthi N, Pendharkar H, Modi S, Kulkarni A. Profile of patients with craniovertebral junction anomalies with posterior circulation strokes. J Stroke Cerebrovasc Dis 2014; 23:2819-2826. [PMID: 25314945 DOI: 10.1016/j.jstrokecerebrovasdis.2014.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/28/2014] [Accepted: 07/07/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Craniovertebral junction (CVJ) anomalies are rare and treatable risk factors for posterior circulation strokes (PCSs). Most of the literature comprises case reports and from varied specialities. METHODS Chart review of patients with PCS with CVJ anomalies admitted in a single tertiary stroke care unit. We describe their clinical profile, investigative findings, and therapeutic outcomes. RESULTS We saw 7 patients (6 males, mean age 20.1 ± 12.0 years), all previously undiagnosed during the 6-year period. Three patients had a combination of atlantoaxial dislocation (AAD), basilar invagination (BI) and Klippel-Feil anomalies, 2 patients had os odontoideum with AAD, and 1 patient each had isolated AAD and BI. Clinically, they presented with first or recurrent episodes of stroke with neck pain. Examination revealed noticeable skeletal markers and neurologic deficits involving the arterial territory. Routine stroke risk factors were absent. X-ray of CVJ was abnormal and diagnostic in all the patients. Other imaging modalities had their own contributions for identifying associated defects, demonstrating pathophysiology, and management of these patients. Acute care with anticoagulation and supportive measures helped in recovery of all of them. Posterior fusion was done in 4 patients, and 2 patients are awaiting the surgery. During follow-up all patients have improved and none had recurrences. CONCLUSIONS In case of a young patient with PCS (first/recurrent) in the absence of routine risk factors for stroke, careful physical examination and imaging with basic X-ray may help in the diagnosis CVJ abnormalities, which may be effectively managed by a multidisciplinary team to prevent recurrences.
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Affiliation(s)
- Girish Baburao Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
| | - Veerendrakumar Mustare
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Nupur Pruthi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Hima Pendharkar
- Department of Neuroradiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Shailesh Modi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Advaith Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Graillon N, Rakotozanani P, Graillon T, Dufour H, Fuentes S. [Acute decompensation of os odontoideum in the elderly. Case report]. Neurochirurgie 2013; 59:195-7. [PMID: 24183190 DOI: 10.1016/j.neuchi.2013.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 07/01/2013] [Accepted: 08/30/2013] [Indexed: 10/26/2022]
Abstract
Os odontoideum is a lesion of the second cervical vertebra, usually revealed by a neurological decompensation due to a neck injury in young adults. We report the exceptional case of an os odontoideum decompensation in a 81-year-old patient, who became quadriplegic after a fall. Subsequent surgical treatment resulted in complete neurological recovery. Os odontoideum can decompensate at all ages, and the authors recommend preventive surgical treatment in cases of instability, including in the elderly.
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Affiliation(s)
- N Graillon
- Service de neurochirurgie, hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
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Klimo P, Coon V, Brockmeyer D. Incidental os odontoideum: current management strategies. Neurosurg Focus 2012; 31:E10. [PMID: 22133185 DOI: 10.3171/2011.9.focus11227] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Os odontoideum was first described in the late 1880s and still remains a mystery in many respects. The genesis of os odontoideum is thought to be prior bone injury to the odontoid, but a developmental cause probably also exists. The spectrum of presentation is striking and ranges from patients who are asymptomatic or have only neck pain to those with acute quadriplegia, chronic myelopathy, or even sudden death. By definition, the presence of an os odontoideum renders the C1-2 region unstable, even under physiological loads in some patients. The consequences of this instability are exemplified by numerous cases in the literature in which a patient with os odontoideum has suffered a spinal cord injury after minor trauma. Although there is little debate that patients with os odontoideum and clinical or radiographic evidence of neurological injury or spinal cord compression should undergo surgery, the dispute continues regarding the care of asymptomatic patients whose os odontoideum is discovered incidentally. The authors' clinical experience leads them to believe that certain subgroups of asymptomatic patients should be strongly considered for surgery. These subgroups include those who are young, have anatomy favorable for surgical intervention, and show evidence of instability on flexion-extension cervical spine x-rays. This recommendation is bolstered by the fact that surgical fusion of the C1-2 region has evolved greatly and can now be done with considerable safety and success. When atlantoaxial instrumentation is used, fusion rates for os odontoideum should approach 100%.
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Affiliation(s)
- Paul Klimo
- Semmes-Murphey Neurologic & Spine Institute, Memphis, Tennessee 38120, USA.
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Chen Z, Jian FZ, Wang K. Diagnosis and treatment of vertebral artery dissection caused by atlantoaxial dislocation. CNS Neurosci Ther 2012; 18:876-7. [PMID: 22900935 DOI: 10.1111/j.1755-5949.2012.00376.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 06/23/2012] [Accepted: 07/01/2012] [Indexed: 11/29/2022] Open
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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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Yamamoto T, Kurosawa K, Masuno M, Okuzumi S, Kondo S, Miyama S, Okamoto N, Aida N, Nishimura G. Congenital anomaly of cervical vertebrae is a major complication of Rubinstein-Taybi syndrome. Am J Med Genet A 2005; 135:130-3. [PMID: 15832359 DOI: 10.1002/ajmg.a.30708] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Rubinstein-Taybi syndrome (RTS; MIM# 180849) is a well-known malformation syndrome, characterized by broad thumbs and halluces, a characteristic facies, short stature, and mental retardation. RTS is accompanied by a variety of morbid complications, particularly of the skeleton. Based on the experience of five RTS patients with malformation of the craniovertebral junction, we draw attention to previously unrecognized life-threatening complications of RTS, including instability of C1-C2, os odontoideum, hypoplasia of the dens, and fusion of the cervical vertebrae. One patient developed severe cervical myelopathy. Malformation of the cervical spine may be a common syndromic constituent of RTS, to which special attention should be paid to prevent its neurologic sequelae.
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Affiliation(s)
- Toshiyuki Yamamoto
- Department of Medical Genetics, Clinical Research Institute, Kanagawa Children's Medical Center (KCMC), Yokohama, Japan.
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