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Wu J, Li Y, Chen F, Wang H, Ni B, Yang H, Guo Q. The Relationship Between Cervical Sagittal Balance and Type of Atlantoaxial Dislocation Secondary to Os Odontoideum. World Neurosurg 2023; 175:e959-e963. [PMID: 37084842 DOI: 10.1016/j.wneu.2023.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE To analyze the effect of cervical sagittal balance on the direction and type of atlantoaxial dislocation. METHODS Data of 55 patients seen at our hospital for atlantoaxial instability/dislocation caused by os odontoideum were reviewed. Radiographic variables, including T1 slope (T1S), C1-C2 angle, C2-C7 angle, C1-C2 sagittal vertical axis (SVA), C2-C7 SVA, and atlanto-dens interval (ADI), were measured preoperatively. Patients were divided into three groups according to ADI: anterior atlantoaxial dislocation, atlantoaxial instability, and posterior atlantoaxial dislocation. Differences within and between groups in radiographic variables and relationships between the investigated variables were analyzed. RESULTS ADI was strongly negatively associated with C1-C2 angle (r = -0.805, P < 0.05); whereas ADI had a medium-strength positive relationship with C2-C7 angle (r = 0.425, P < 0.05) and a medium-strength negative relationship with C2-C7 SVA (r = -0.411, P < 0.05). However, ADI was not significantly correlated with T1 slope (r = -0.092, P > 0.05). CONCLUSIONS The type and direction of atlantoaxial dislocation is closely associated with cervical sagittal balance. C2-C7 SVA is an important factor in assessing the direction of atlantoaxial subluxation secondary to os odontoideum. ADI decreases with increasing C2-C7 SVA. The larger the C2-C7 SVA, the more likely the atlantoaxial dislocation is to be posterior.
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Affiliation(s)
- Ji Wu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, PR China
| | - Yang Li
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, PR China
| | - Fei Chen
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, PR China
| | - Haibin Wang
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, PR China
| | - Bin Ni
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, PR China.
| | - Haisong Yang
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, PR China
| | - Qunfeng Guo
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, PR China
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Buttock carbuncle with severe hypothermia and disturbed consciousness: When os odontoideum is the answer. Clin Neurol Neurosurg 2020; 196:105914. [DOI: 10.1016/j.clineuro.2020.105914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 11/24/2022]
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Öğüt E, Şekerci R, Şen H, Çakın H, Gediz T, Keles-Celik N. Anatomo-radiological importance and the incidence of os odontoideum in Turkish subjects: a retrospective study. Surg Radiol Anat 2020; 42:701-710. [DOI: https:/doi.org/10.1007/s00276-020-02421-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/13/2020] [Indexed: 07/22/2023]
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Anatomo-radiological importance and the incidence of os odontoideum in Turkish subjects: a retrospective study. Surg Radiol Anat 2020; 42:701-710. [PMID: 31989216 DOI: 10.1007/s00276-020-02421-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Os odontoideum is a rare anatomical and morphological variation of the odontoid process and associated with a range of symptoms such as spinal cord and vertebral artery injuries. This study aimed to evaluate the frequency of os odontoideum in Turkish cases by sagittal/coronal cervical magnetic resonance imaging (MRI) and computed tomography (CT) and analyze the relationship with age, gender and related symptoms. METHODS The incidence of os odontoideum was retrospectively diagnosed by sagittal/coronal cervical CT and MRI out of 16,122 subjects aged 20-70 years (mean 46) in the period between 2014 and 2018. The relationship of os odontoideum with age, gender, and symptoms was recorded. RESULTS The statistical analysis of the study was performed by the χ² test and two-way mixed ANOVA. Os odontoideum was detected in 18 (0.11%) (11 males; 7 females) out of 16,122 patients. The mean age was 47.5 ± 1.4 years in the females and 43.5 ± 2.5 years in the males (p < 0.05). 6 odontoideum were detected out of 6467 (3756 males, mean 48 ± 0.7, 2711 females, mean 46 ± 1.2) subjects by CT and 12 odontoideum were detected out of 9655 patients (5607 males and 4048 females) by MRI. CONCLUSION Neck pain was the most frequent symptom. The prevalence of os odontoideum especially round type is more frequent in older male patients over 40 years old with head and neck pain or atlantoaxial instability, and is less common in Turkish subjects when compared to various ethnic groups.
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Shao J, Gao YZ, Gao K, Yu ZH. Posterior Screw-Rod Fixation and Selective Axial Loosening for the Treatment of Atlantoaxial Instability or Dislocation Caused by Os Odontoideum: A Case Series for a Single Posterior Approach. World Neurosurg 2019; 132:e193-e201. [PMID: 31493594 DOI: 10.1016/j.wneu.2019.08.208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/24/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the effect of screw-rod fixation and selective axial loosening in the treatment of atlantoaxial instability or dislocation (including reducible and irreducible) caused by os odontoideum (OO) via a single posterior approach. METHODS A consecutive series of patients with OO surgically treated in our hospital were retrospectively analyzed. For atlantoaxial instability and reducible atlantoaxial dislocation, C1-C2 screw-rod fixation and fusion were performed. OO combined with irreducible atlantoaxial dislocation was reduced after posterior axial loosening, followed by screw-rod fixation and fusion. The general information, clinical data, and radiographic data were compared between the 2 different procedures. RESULTS There were 41 patients with an average age of 40.6 ± 21.7 years. All the patients underwent posterior reduction and C1-2 screw rod fixation, 6 with axial loosening and 35 without axial loosening. The clinical manifestations and radiographic data significantly improved after the operation with a low rate of complications. Except for clivus-canal angle and visual analogue score of cervical pain, there were no differences in clinical and radiographic data between the 2 procedures. CONCLUSIONS Posterior screws-rod fixation and selective axial loosening is appropriate for treating OO complicated with atlantoaxial instability or dislocation (including reducible and irreducible) without the need for anterior decompression.
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Affiliation(s)
- Jia Shao
- Department of Spinal Surgery, Henan Provincial People's Hospital, Henan, China
| | - Yan Zheng Gao
- Department of Spinal Surgery, Henan Provincial People's Hospital, Henan, China.
| | - Kun Gao
- Department of Spinal Surgery, Henan Provincial People's Hospital, Henan, China
| | - Zheng Hong Yu
- Department of Spinal Surgery, Henan Provincial People's Hospital, Henan, China
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Abbritti RV, Esposito F, Angileri FF, Cacciola F, Marino D, La Fata G, Gorgoglione N, Raffa G, Scibilia A, Germanò A. Endoscopic Endonasal Odontoidectomy and Posterior Fusion in a Single-Stage Surgery: Description of Surgical Technique and Outcome. ACTA NEUROCHIRURGICA. SUPPLEMENT 2019; 125:197-207. [PMID: 30610323 DOI: 10.1007/978-3-319-62515-7_29] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This paper has been edited for clarity, correctness and consistency with our house style. Please check it carefully to make sure the intended meaning has been preserved. If the intended meaning has been inadvertently altered by the editing changes, please make any corrections needed.
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Affiliation(s)
- Rosaria Viola Abbritti
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Felice Esposito
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy.
| | - Filippo Flavio Angileri
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Fabio Cacciola
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Daniele Marino
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Giuseppe La Fata
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Nicola Gorgoglione
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Giovanni Raffa
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
- Department of Clinical and Experimental Medicine, Università degli Studi di Messina, Messina, Italy
| | - Antonino Scibilia
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Antonino Germanò
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
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Posterior C1-C2 screw-rod fixation and autograft fusion for the treatment of os odontoideum with C1-C2 instability. Clin Neurol Neurosurg 2017; 163:71-75. [PMID: 29078125 DOI: 10.1016/j.clineuro.2017.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/14/2017] [Accepted: 10/19/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To report our experience treating os odontoideum with C1-C2 instability via C1-C2 screw-rod fixation and autograft fusion and to explore the clinical efficacy of such a treatment strategy. PATIENTS AND METHODS We retrospectively reviewed the medical records of patients who were diagnosed with os odontoideum with C1-C2 instability and treated by posterior C1-C2 screw-rod fixation and fusion. Neurological deficits were measured with the Japanese Orthopedic Association (JOA) scoring system and neck pain was assessed using the Visual Analogue Scale (VAS) score. Fusion was determined based on the presence of bridging bone in computed tomography (CT) imaging, whereas stability was determined based on the lack of movement in dynamic radiographs. RESULTS Thirty-two patients (18 males) were included in the study. The surgery was successfully accomplished in all patients. Thirty (93.8%) patients had confirmed C1-C2 bony fusion in CT images and all patients (100%) were stable in dynamic radiographs. The mean preoperative JOA score was 14.3±1.4 (range 11-16); at the final visit, it increased to 16.2±0.8 (range 14-17) (p<0.001). The mean preoperative VAS score was 3.8±0.7 (range 3-5) and decreased at the final visit to 1.0±0.6 (range 0-2) (p<0.001). CONCLUSION Our treatment strategy (C1-C2 screw-rod fixation and autograft fusion) can achieve excellent clinical results with minor complications for patients with os odontoideum with C1-C2 instability.
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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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Atlantoaxial dislocation and os odontoideum in two identical twins: perspectives on etiology. 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 2017; 27:259-263. [DOI: 10.1007/s00586-017-5116-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/10/2017] [Accepted: 04/30/2017] [Indexed: 10/19/2022]
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Dias RP, Buchanan CR, Thomas N, Lim S, Solanki G, Connor SEJ, Barrett TG, Kapoor RR. Os odontoideum in wolcott-rallison syndrome: a case series of 4 patients. Orphanet J Rare Dis 2016; 11:14. [PMID: 26860746 PMCID: PMC4748609 DOI: 10.1186/s13023-016-0397-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 02/03/2016] [Indexed: 02/07/2023] Open
Abstract
Wolcott-Rallison Syndrome is the commonest cause of neonatal diabetes in consanguineous families. It is associated with liver dysfunction, epiphyseal dysplasia, and developmental delay. It is caused by mutations in eukaryotic translation initiation factor 2-α kinase 3 (EIF2AK3). We report 4 children with WRS and Os Odontoideum resulting in significant neurological compromise. This cervical spine abnormality has not previously been described in this syndrome. This additional evidence broadens the clinical spectrum of this syndrome and confirms the role of EIF2AK3 in skeletal development. Furthermore, Os Odontoideum needs to be actively screened for in WRS patients to prevent neurological and respiratory compromise.
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Affiliation(s)
- R P Dias
- Department of Paediatric Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham, B4 6NH, UK
| | - C R Buchanan
- Department of Child Health, King's College Hospital, London, SE5 9RS, UK
| | - N Thomas
- Department of Neurosurgery, Kings College Hospital, London, SE5 9RS, UK
| | - S Lim
- Department of Paediatrics, St John's Hospital, Chelmsford, Essex, CM2 9BG, USA
| | - G Solanki
- Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, B4 6NH, UK
| | - S E J Connor
- Department of Neuroradiology, Kings College Hospital, London, SE5 9RS, UK
| | - T G Barrett
- Department of Paediatric Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham, B4 6NH, UK.,Centre for Rare Diseases and Personalized Medicine, Institute of Biomedical Research (West), School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, B15 2TT, UK
| | - R R Kapoor
- Department of Child Health, King's College Hospital, London, SE5 9RS, UK.
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Visocchi M, Di Rocco C. Os odontoideum syndrome: pathogenesis, clinical patterns and indication for surgical strategies in childhood. Adv Tech Stand Neurosurg 2014; 40:273-93. [PMID: 24265050 DOI: 10.1007/978-3-319-01065-6_9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Os odontoideum is a rare condition with a controversial pathogenesis and poorly understood natural history. Hypoplasia of the odontoid associated with an independent oval ossicle, with smooth margins widely separated from C2 and well above the superior facets of the axis, is termed "os odontoideum". The neurological manifestations arise from bulbospinal compression both at rest and during motion, due to the craniovertebral junction (CVJ) instability itself. Consequently, the surgical management of os odontoideum should aim at achieving both neural decompression and stabilization of the CVJ. The aims of this paper are to introduce the embryological steps involved in the CVJ development, to underline the updated theories propounded to interpret developmental and congenital disorders of the os odontoideum, to introduce the most updated surgical techniques and to discuss some exemplary cases selected from our personal experience.
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Affiliation(s)
- Massimiliano Visocchi
- Department of Head Neck Diseases, Institute of Neurosurgery, Catholic University of Rome, Largo Gemelli, 8, Rome, 0068, Italy,
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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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Treatment strategies for severe C1C2 luxation due to congenital os odontoideum causing tetraplegia. 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; 22:29-35. [PMID: 22581189 DOI: 10.1007/s00586-012-2329-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE High-grade C1C2 luxation is a rare pathology. There is no clear evidence as to how to treat this deformity. There is only limited evidence about the different surgical techniques and possible approaches including advantages, disadvantages, and complications. METHODS This is an uncommon case of a 13-year-old child with progressive, tetraplegia due to congenital os odontoideum with translational instability between C1 and C2, and progressive luxation of C2. An irreducible dislocation of the C0/C1 complex caused significant compression at the cervicomedullary junction and neurologic deficit. In this paper we highlight the different types of os odontoideum, a review of existing evidence of surgical correction. We will discuss the different treatment strategies which could be applied and the current solution will be described. RESULTS Continuous skeletal traction and translational reduction was achieved by a specially designed halo traction system including continuous skeletal traction in a wheelchair for 6 weeks. The surgical treatment consisted of a posterior only release, translational reduction and posterior instrumentation from C0 to C4 with a Y plate and homologous bone graft. Neurological deficits started to improve during halo traction. After surgery the patient was ambulatory without any assistance and reached a Frankel stage E. Postoperative X-rays and CT scan revealed complete reduction at the C1/C2 level and a decompressed cervicomedullary junction. CONCLUSION Treatment of severe C1C2 luxation is difficult with limited evidence in the literature. The current case shows a successful treatment strategy to reduce the deformity and lists alternative approaches.
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Wang S, Wang C. Acquired os odontoideum: a case report and literature review. Childs Nerv Syst 2012; 28:315-9. [PMID: 22134416 DOI: 10.1007/s00381-011-1642-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 11/18/2011] [Indexed: 10/15/2022]
Affiliation(s)
- Shenglin Wang
- Orthopaedic Department, Peking University Third Hospital, 49 North Garden Street, Haidian District, Beijing, China
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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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Brecknell JE, Malham GM. Os odontoideum: report of three cases. J Clin Neurosci 2008; 15:295-301. [PMID: 18178439 DOI: 10.1016/j.jocn.2006.07.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Revised: 07/03/2006] [Accepted: 07/14/2006] [Indexed: 11/15/2022]
Abstract
Os odontoideum is a condition in which a smoothly corticated ossicle exists dorsal to the anterior arch of C1, taking the place of the rostral dens, but with no bony connection to the body of the axis. Three patients presented with this condition: the first with Lhermitte's phenomenon 10 years after significant trauma, the second as an incidental finding during routine cervical spine imaging following a road traffic accident, and the third with recurrent transient quadriparesis precipitated by falls from a surfboard. Patients had at least 10 mm of sagittal instability on dynamic imaging and the second patient had a minimum sagittal canal diameter of only 11.5 mm. Posterior atlanto-axial fixation was successfully achieved in all cases using polyaxial screws and rods with the assistance of computed tomography-based image guidance. Image guidance provided an invaluable aid to preoperative planning and intraoperative placement of the posterior spinal instrumentation.
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Affiliation(s)
- J E Brecknell
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia.
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Shetty GM, Song HR, Unnikrishnan R, Suh SW, Lee SH, Hur CY. Upper cervical spine instability in pseudoachondroplasia. J Pediatr Orthop 2008; 27:782-7. [PMID: 17878785 DOI: 10.1097/bpo.0b013e3181558c1d] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pseudoachondroplasia (PSACH) is a rare autosomal dominant skeletal dysplasia associated with os odontoideum and atlantoaxial instability. This study aims to define the characteristics of upper cervical spine instability in patients with PSACH and analyze the relation between the incidence of upper cervical instability and os odontoideum. METHODS Fifteen patients (10 women and 5 men) with PSACH of Korean ethnicity with mean age of 23.7 years (range, 3-44 years) at presentation to our hospital with varied complaints, including short stature, limb deformity, neck pain, and neurological symptoms, were evaluated clinicoradiologically for upper cervical spine instability. The patients were separated into group 1 (n = 9) with os odontoideum and group 2 (n = 6) without os odontoideum. Comparisons were made using parameters such as instability index, rotational instability, atlantodens interval and space available for cord, and analysis done to correlate cervical instability with age and Japanese Orthopedic Association (JOA) score. RESULTS Significant differences were found statistically when the 2 groups were compared on the basis of the space available for the cord (SAC), JOA scoring, and rotational instability. Linear relationship was found between instability and age and JOA score. Incidence of os odontoideum was 60% in our study group. CONCLUSIONS Os odontoideum led to an increase in the incidence of upper cervical spine instability. Instability increased with the age. The presence of os odontoideum and atlantoaxial instability did not warrant for surgery because no signs of cervical myelopathy developed or progressed in our patients during the follow-up period, but these patients should undergo regular clinical and radiological evaluation. LEVEL OF EVIDENCE Level IV prognostic study.
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Affiliation(s)
- Gautam M Shetty
- Department of Orthopedic Surgery, Korea University Guro Hospital, Rare Disease Institute, Seoul, Korea
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Vargas TM, Rybicki FJ, Ledbetter SM, MacKenzie JD. Atlantoaxial instability associated with an orthotopic os odontoideum: a multimodality imaging assessment. Emerg Radiol 2005; 11:223-5. [PMID: 16133608 DOI: 10.1007/s10140-005-0406-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Accepted: 12/20/2004] [Indexed: 11/24/2022]
Abstract
Radiography, computed tomography (CT), and magnetic resonance imaging exams of the cervical spine were performed in a 29-year-old man who was ultimately diagnosed with an orthotopic os odontoideum during admission for injuries sustained in a motor vehicle collision. Initial radiography suggested either os odontoideum or an acute fracture of the dens. Further imaging with CT and flexion and extension radiographs confirmed os odontoideum and excluded a dens fracture. Although rare, os odontoideum is an important cervical spine anomaly to consider and to distinguish from an acute fracture of the dens.
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Affiliation(s)
- Tomas M Vargas
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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Isenberg J, Andermahr J, Hahn U. [Multidirectional atlantoaxial instability of an os odontoideum in an adult]. Unfallchirurg 2005; 107:1089-92. [PMID: 15241606 DOI: 10.1007/s00113-004-0788-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Increasing neck pain in a 29 year old woman after a frontal car collision gave reason for a conventional x-ray that presented a traumatically displaced os odontoideum positioned at the top of the dens axis. No neurological defect was seen. Dynamic flexion/extension film showed a movement to an atlantoaxial dislocation with a shift of the os odontoideum. The sclerotic structure of the corresponding bony surfaces was confirmed by computed tomography, whereas magnetic resonance imaging demonstrated a posttraumatic signal change in front of the base of dens axis and os odontoideum. Fusion was achieved by computed navigation with C1/C2 transfacetal screws as described by Magerl and interspinal fusion with a bicortical autologous iliac crest graft and a posterior tension band as described by Brooks. An exact positioning of screws past the asymmetric course of both arteria vertebrales was possible by navigation. The patient was free of pain 5 months after the fusion.
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Affiliation(s)
- J Isenberg
- Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universität, Köln.
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Laidlaw JD, Kavar B, Siu KH. Acute atlanto-axial post-operative subluxation following posterior C1/2 fusion. J Clin Neurosci 2004; 11:172-8. [PMID: 14732379 DOI: 10.1016/j.jocn.2003.07.002] [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: 10/26/2022]
Abstract
Two cases referred with acute post-operative C1/2 subluxation following posterior fusion are reported. Both cases had initial treatment for atlanto-axial instability with posterior cable (Brooks and interspinous) and graft techniques, and placed immediately in a Philadelphia collar. One case was found to have subluxed immediately post-operatively when failing to breathe following reversal of anaesthetic agents, and despite immediate realignment and reoperation was left with a significant quadriparesis. The other patient was noted to have subluxed on routine X-ray on day 4, and had no neurological deficit before or after reoperation. Risk factors for this dangerous complication are discussed and the techniques of C1/2 posterior fusion and stabilization are reviewed in detail. Surgeons performing atlanto-axial stabilization procedures should be familiar with and have expertize in the complete range of techniques described and choose the one most appropriate for the patient's individual requirements.
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Affiliation(s)
- John D Laidlaw
- Department of Neurosurgery, University of Melbourne, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
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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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Galli J, Tartaglione T, Calo L, Ottaviani F. Os odontoideum in a patient with cervical vertigo: a case report. Am J Otolaryngol 2001; 22:371-3. [PMID: 11562892 DOI: 10.1053/ajot.2001.26503] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cervical vertebral anomalies are often associated with malformations or traumas, they may be completely asymptomatic and represent an occasional finding in vertigo or can cause severe neurologic complications (ie, compression of the upper cervical spine with myelopathy, epilepsy, or respiratory failure). This clinical case is a patient who came to us for observation for a peripheral harmonic vestibular syndrome, and in whom a malformation of the cervical vertebral joint (os odontoideum) was occasionally found on magnetic resonance imaging.
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Affiliation(s)
- J Galli
- Institute of Otorhinolaryngology, University of the Sacred Heart ROMA, Rome, Italy
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Chang H, Park JB, Kim KW, Choi WS. Retro-dental reactive lesions related to development of myelopathy in patients with atlantoaxial instability secondary to Os odontoideum. Spine (Phila Pa 1976) 2000; 25:2777-83. [PMID: 11064523 DOI: 10.1097/00007632-200011010-00010] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective analysis of 13 patients with atlantoaxial instability secondary to Os odontoideum who underwent posterior atlantoaxial fusion. OBJECTIVE To assess the relationships between the development of myelopathy and plain radiographic parameters in patients with atlantoaxial instability secondary to Os odontoideum and to determine whether the pathologic structures, which compress the spinal cord, are visualized using magnetic resonance imaging. SUMMARY OF BACKGROUND DATA The development of myelopathy, which is the most serious complication associated with Os odontoideum, was thought to be related to either the degree of instability or direction of instability, or a decrease in the space available for the cord. However, such indirect radiographic parameters measured using plain radiographs cannot provide direct information concerning the causes of myelopathy in patients with atlantoaxial instability secondary to Os odontoideum. METHODS Thirteen patients who underwent posterior atlantoaxial fusion for clinical symptoms due to Os odontoideum were classified into two groups depending on whether they had (n = 9) or did not have (n = 4) myelopathy. Four radiographic parameters were measured using flexion and extension lateral radiographs; the degree of instability, the direction of instability, and the space available for the cord in flexion and extension. MRI was performed on all patients in the myelopathy group. The radiologic and clinical data were compared for the two groups. RESULTS There were no significant statistical differences in the degree of instability (6.83 vs. 7.38, P = 0.816), space available for the cord in flexion (6.94 vs. 7.13, P = 0.938), and space available for cord in extension (7.56 vs. 5.75, P = 0.434) between the two groups. There was a poor agreement between the direction of instability and the development of myelopathy (kappa = 0.268, P = 0.308). Magnetic resonance imaging did demonstrate, however, cord compression caused by retro-dental reactive lesions in the myelopathy; cystic masses were present in two patients; and fibrocartilaginous masses were present in seven. CONCLUSION The current study suggests that the value of plain radiographic parameters should be reevaluated as a means of evaluating myelopathy in patients with atlantoaxial instability secondary to Os odontoideum, and that retro-dental reactive lesions should be considered as the potential cause of myelopathy.
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Affiliation(s)
- H Chang
- Department of Orthopaedic Surgery, Uijongbu St. Mary's Hospital, The Catholic University of Korea
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