Os Odontoideum: A Comprehensive Clinical and Surgical Review

Jumah, Fareed; Alkhdour, Saja; Mansour, Shaden; He, Puhan; Hroub, Ali; Adeeb, Nimer; Hanif, Rimal; Mortazavi, Martin M.; Tubbs, R. Shane; Nanda, Anil

doi:10.7759/cureus.1551

Cited by 22 publications

(35 citation statements)

References 49 publications

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“…Some OO cases can be observed together with BI. Neck pain, torticollis, myelopathy, and syncope can be observed as clinical findings (12,13). In our study, the rate of OO was 0.51% and it was observed more frequently in male patients.…”

Section: Discussionsupporting

confidence: 49%

Rare Congenital Anomalies at the Craniovertebral Junction; Os Odentoideum

Guntel¹,

Bayarogullari²

2021

Preprint

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Aim: We aimed to identify dislocation, myelomalacia, and other congenital pathologies that may cause neurological complications arising from the odontoid process in the craniocervical junction (CVJ) of patients who were performed cervical tomography due to various complaints. Materials and Methods: Patients who were performed cervical CT with various complaints between 2010 and 2018 were retrospectively screened and evaluated, from the hospital registry system. Segmentation and fusion anomalies arising from the odontoid process in the craniovertebral junction area, as well as other accompanying pathologies such as subluxation, dislocation, compression to the spinal cord, and myelomalacia were also recorded. An additional 1.5 Tesla cervical MRI was performed for the 12 patients with os odontoideum. Radiological evaluation was performed on the workstation by an experienced radiologist. Results: 2525 patients with cervical CT were included in the study. 67 of these patients had congenital anomalies at the CVJ. 13 of 67 patients had os odontoideum, 38 had Klippel-Feil syndrome (KFS). Atlanto-occipital assimilation (AOA) and KFS often saw together. Only AOA was observed in 16 cases. Neck pain and limitation of movement were the most common findings in patients with congenital anomalies in the CVJ region. Conclusion: Congenital anomalies at the CVJ region, although rare, can cause mortality or morbidity. Cervical CT and MRI studies on the CVJ region should be evaluated carefully by the clinicians due to the risk of various complications.

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Section: Discussionsupporting

confidence: 49%

Rare Congenital Anomalies at the Craniovertebral Junction; Os Odentoideum

Guntel¹,

Bayarogullari²

2021

Preprint

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“…Os odontoideum was noted in two cases. In this, odontoid process may remain separate from the body of the axis partially or completely [ 24 ]. In four cases, Os terminale was seen.…”

Section: Discussionmentioning

confidence: 99%

Embryological considerations and evaluation of congenital anomalies of craniovertebral junction

Ravikanth¹,

Majumdar²

2021

Tzu Chi Medical Journal

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Objectives: Craniovertebral junction (CVJ) abnormalities constitute a group of treatable neurological disorders, especially in the Indian subcontinent. Thus, it is essential that clinicians should be able to make a precise diagnosis of abnormalities and rule out important mimickers on multidetector computed tomography (MDCT) as this information ultimately helps determine the management, prognosis, and quality of life of patients. CVJ is the most complex part of the cervical region. Congenital malformations of this region can cause serious neurological deficit and require a surgical intervention. The present study was undertaken to know the embryological basis of the CVJ and to identify commonly observed congenital CVJ abnormalities, their frequency, and mode of presentation. Materials and Methods: Diagnosed cases of CVJ anomalies on dynamic MDCT head were reviewed at a tertiary care center between January 2014 to December 2019. Type of anomaly, clinical presentation, and associated malformations were recorded. Different types of variations were expressed in terms of percentage. Results: Congenital anomalies were seen in 42 cases. Fifteen types of anomalies were detected. Anomalies were either singly or in combination. The CVJ anomalies were more common in young adults (28%), almost equal in both sexes. The most common anomaly was basilar invagination (52.3%), followed by atlanto-occipital assimilation (33.3%), and Arnold–Chiari malformation is the most common soft tissue anomaly. In fourteen cases, additional anomalies of other vertebrae were present. The most common symptoms were weakness of extremities, neck pain, paresthesia, torticollis, and gait disturbances. About 28 patients got improved, 8 patients had residual deficit as that of preoperative status, and 4 patients got deteriorated after surgery, at 1-month follow-up. About 34 patients had improved, 5 remained static, and 3 patients got worsened at the end of 3-month follow-up. About 37 patients had improved, 4 patients remained static, and 2 patients got deteriorated at 6 months of follow-up. The patients with increased atlantodens interval 3–5 mm showed 77% improvement after surgery. Conclusion: Congenital CVJ anomalies, though rare, are fatal. CVJ abnormalities constitute an important group of treatable neurological disorders with diagnostic dilemma. The atlantodental interval is the most important preoperative prognostic marker. Dynamic CT imaging can provide additional useful information to the diagnosis of CVJ instability. To prevent long-term neurological problems, early diagnosis and treatment of congenital bony CVJ anomalies is important.

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“…Rregardless of its etiology, Os Odontoideum remains a major compromise to atlanto-axial stability, even under physiological loads in some individuals, plac-ing the spinal cord and the vertebral artery at a significant risk of injury [14].…”

Section: Discussionmentioning

confidence: 99%

Os Odontoideum: Report of Eight Cases and Review of the Literature

Mahmoud¹,

Hammad²,

Abdrabou³

2020

OJMN

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Background: Os odontoideum is a separate odontoid process from the body of the axis. It is a rare anomaly of the craniovertebral junction with evidence of both congenital and acquired causes but the aetiology still debated in the literature. It can lead to instability of the atlantoaxial joint and places the spinal cord at significant risk. Methods: Eight cases of os odontoideum were symptomatic at time of presentation, submitted for general and neurological examination, and investigated with different radiological modalities and managed with surgical fixation and stabilization. These patients followed for one year postoperatively. Results: The study includes six male patients and two female patients with median age 18.7 years. All patients presented with myelopathy and showed clinical evidence of atlantoaxial instability. They submitted for complete radiological investigations (plain x ray, CT scan and MRI) craniocervical junction. They underwent cervical surgical stabilization, two cases by atlantoaxial arthrodesis with wiring, two atlantoaxial fixation by lateral mass screw one of them with transoral odontoiectomy, two atlantoaxial fixations by a Rosen's Hooks, and two cases craniocervical fixation by Tie frame. Death postoperatively recorded in two patients. Follow-up one year revealed resolution of symptoms in two patients and four patients remained stationary but without deterioration. Conclusion: Os odontoideum is a rare but sometimes lethal abnormality that requires radiological and clinical judgement to ensure the best choice of management and optimum patient's care.

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Os Odontoideum: A Comprehensive Clinical and Surgical Review

Cited by 22 publications

References 49 publications

Rare Congenital Anomalies at the Craniovertebral Junction; Os Odentoideum

Rare Congenital Anomalies at the Craniovertebral Junction; Os Odentoideum

Embryological considerations and evaluation of congenital anomalies of craniovertebral junction

Os Odontoideum: Report of Eight Cases and Review of the Literature

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