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Published on: August 22, 2022
Os odontoideum: report of three cases
1Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia. johnbrecknell@hotmail.com
Summary
Os odontoideum, a rare spinal condition, can cause neurological issues. Surgical fixation using image-guided technology proved effective in stabilizing the atlantoaxial joint in three patients.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Imaging
Background:
- Os odontoideum is a congenital or acquired anomaly characterized by an ossicle replacing the dens of the axis (C2) without bony union.
- This condition can lead to atlantoaxial instability and neurological deficits, often presenting after trauma or as an incidental finding.
- Surgical intervention is considered for symptomatic cases with significant instability.
Observation:
- Three patients with os odontoideum presented with varied symptoms, including Lhermitte's phenomenon, transient quadriparesis, and incidental findings.
- Dynamic imaging revealed significant sagittal instability (≥10 mm) in all patients.
- One patient exhibited a critical sagittal canal diameter of 11.5 mm, highlighting the risk of spinal cord compression.
Findings:
- Posterior atlantoaxial fixation using polyaxial screws and rods was successfully performed in all three cases.
- Computed tomography (CT)-based image guidance significantly aided preoperative planning and intraoperative instrumentation placement.
- The surgical technique ensured stable fixation and addressed the underlying instability.
Implications:
- Os odontoideum requires careful evaluation for instability and potential neurological compromise.
- CT-based image guidance is a valuable tool for complex atlantoaxial fixation, enhancing surgical precision and safety.
- Surgical stabilization offers a successful treatment option for patients with symptomatic os odontoideum and significant instability.
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