Incidental os odontoideum: current management strategies

Area of Science:

• Orthopedics
• Neurosurgery
• Developmental Biology

Background:

• Os odontoideum, a rare anomaly of the upper cervical spine, presents diagnostic and therapeutic challenges.
• Its etiology is debated, with theories including prior bone injury or developmental abnormalities.

Observation:

• Patients with os odontoideum exhibit a wide range of symptoms, from asymptomatic to severe neurological deficits like quadriplegia.
• The condition inherently causes instability in the C1-2 region, increasing the risk of spinal cord injury from minor trauma.

Findings:

• While surgical intervention is standard for symptomatic patients, the management of asymptomatic individuals remains controversial.
• The authors advocate for surgical consideration in specific asymptomatic subgroups, including young patients with favorable anatomy and radiographic evidence of instability.

Implications:

• Advancements in C1-2 fusion techniques offer high success rates, approaching 100% with atlantoaxial instrumentation.
• Proactive surgical management in select asymptomatic cases may prevent catastrophic neurological injury and improve patient outcomes.