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Pathogenesis, dynamics, and management of os odontoideum
Neurosurgical Focus
|September 16, 2006
Summary
Os odontoideum, a rare craniovertebral junction abnormality, is often linked to early childhood trauma. Surgical intervention is recommended for symptomatic cases with abnormal motion dynamics.
Area of Science:
- Neurosurgery
- Orthopedics
- Radiology
Background:
- Os odontoideum is an uncommon craniovertebral junction (CVJ) abnormality characterized by a separate ossicle.
- Its etiology, natural history, and optimal treatment remain subjects of debate.
- This condition can lead to significant neurological compromise.
Purpose of the Study:
- To evaluate the clinical presentation, natural history, and treatment outcomes of symptomatic os odontoideum.
- To investigate the association between early childhood trauma and the development of os odontoideum.
- To determine the role of dynamic imaging in assessing CVJ instability and guiding surgical management.
Main Methods:
- Prospective evaluation of 260 patients with symptomatic os odontoideum over 20 years.
- Detailed history including early childhood trauma, dynamic motion studies using pleuridirectional tomography, CT, CT myelography, and MR imaging.
- Documentation of operative findings and surgical interventions in 134 patients.
Main Results:
- Early childhood trauma was recorded in 74 patients; 30 had normal odontoid processes before age 4.
- Acute neurological deterioration occurred in 63/134 surgically treated patients; 71 had insidious onset.
- Irreducible ventral CVJ disease necessitated transpharyngeal decompression in 28 patients; all required dorsal CVJ arthrodesis.
Conclusions:
- Os odontoideum is likely an acquired phenomenon associated with early childhood trauma.
- Abnormal motion dynamics and neurological deficits are indications for surgical intervention.
- Asymptomatic cases without abnormal motion should be monitored; surgical extension may be needed for recurrent instability.
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