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Os Odontoideum in Children.

Daniel J Hedequist1, Andrew Z Mo

  • 1From the Department of Orthopaedic Surgery, Boston Children's Hospital/Harvard Medical School, Boston, MA (Dr. Hedequist), and the Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY (Dr. Mo).

The Journal of the American Academy of Orthopaedic Surgeons
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Summary

Os odontoideum, a rare C2 vertebra condition, involves a distinct ossicle. Diagnosis and management depend on symptoms and spinal stability, ranging from observation to surgical fusion.

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Area of Science:

  • Orthopedics
  • Radiology
  • Neurology

Background:

  • Os odontoideum is a rare condition affecting the second cervical vertebra (C2).
  • It is characterized by a distinct, corticated ossicle separate from the C2 vertebral body.
  • This entity must be differentiated from odontoid fractures and persistent ossiculum terminale.

Purpose of the Study:

  • To summarize the diagnostic imaging, etiology, clinical presentation, and management of os odontoideum.
  • To highlight the importance of assessing spinal cord integrity and atlantoaxial instability.

Main Methods:

  • Diagnosis is typically made using plain radiographs.
  • Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) are employed to evaluate spinal cord integrity and C1-C2 instability.
  • Etiology is investigated through comparative studies supporting congenital or traumatic origins.

Main Results:

  • Os odontoideum can be incidentally discovered during imaging for neck pain or neurological symptoms.
  • Clinical presentations vary widely, from mild pain to myelopathy or vertebrobasilar ischemia.
  • Radiographic assessment is crucial for determining the presence of atlantoaxial instability.

Conclusions:

  • Asymptomatic cases without instability are managed with observation and serial imaging.
  • Surgical intervention with fusion is indicated for cases demonstrating atlantoaxial instability or neurological deficits.
  • Understanding the varied clinical spectrum and diagnostic modalities is key for effective patient management.