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Retro-odontoid pseudotumor in diffuse idiopathic skeletal hyperostosis
Byung-Yoon Jun1, Kang-Jun Yoon, Alan Crockard
1St. Peter's Spine Center, Seoul, Korea, and the; Department of Surgical Neurology, The National Hospital for Neurology and Neurosurgery, London, United Kingdom. drbyjun@hotmail.com
Spine
|May 11, 2002
Summary
This study presents the first case of a retro-odontoid pseudotumor in diffuse idiopathic skeletal hyperostosis. Mechanical stress on the atlantoaxial segment is proposed as the cause, with surgical removal improving patient function.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Rheumatology
Background:
- Diffuse idiopathic skeletal hyperostosis (DISH) rarely affects the craniovertebral junction.
- Previous reports include atlantoaxial subluxation and odontoid fractures.
- Myelopathy from a retro-odontoid pseudotumor in DISH has not been previously documented.
Observation:
- A 74-year-old male presented with spastic tetraparesis due to a retro-odontoid pseudotumor.
- The pseudotumor was associated with diffuse idiopathic skeletal hyperostosis.
- Surgical intervention involved transoral removal and dorsal atlantoaxial fusion.
Findings:
- Histological analysis revealed degenerated ligament, fibrocartilage, and fibrin, with no evidence of neoplasia.
- The retro-odontoid mass was firmly attached to hypertrophied ligaments.
- Post-surgery, the patient experienced improved neurologic function.
Implications:
- This case highlights a novel presentation of DISH at the craniovertebral junction.
- Mechanical stress is identified as a potential pathomechanism for retro-odontoid pseudotumor formation in DISH.
- Understanding this mechanism may guide future treatment strategies for similar rare conditions.