The Role of Conservative Management in Incidental Os Odontoideum

Os odontoideum is a relatively rare but significant condition of the cervical spine that has potentially life-threatening complications, including vertebral artery dissection, leading to permanent neurologic disability and even death. Unfortunately, the literature is not clear as to the best management approach for os odontoideum. As such, clinicians and their patients are still left with difficult and uncertain treatment decisions in the absence of a clinical consensus.

A 20-year-old male was brought in after an assault and found to have os odontoideum on routine investigation. He was informed of management options and elected to undergo a conservative management approach with radiologic surveillance. The patient subsequently became symptomatic and required surgical fixation.

This case illustrates that in the event an asymptomatic case of os odontoideum with radiological instability is managed conservatively, careful clinical and radiologic follow-up is essential as such cases can become symptomatic.