Upper Cervical Compression Myelopathy Caused by the Retro-Odontoid Pseudotumor With Degenerative Osteoarthritis and Calcium Pyrophosphate Dihydrate Disease: A Case Report and Literature Review

Abstract

The retro-odontoid pseudotumor is often concurrent with atlantoaxial subluxation (AAS). Therefore, the pseudotumor is relatively common in rheumatoid arthritis (RA) but rare in primary osteoarthritis (OA). This is a case report of an elderly male patient suffering from neck pain and compression myelopathy caused by the craniocervical pseudotumor with OA but without atlantoaxial instability. He had long-lasting peripheral and spinal pain treated by nonsteroidal anti-inflammatory drugs. Imaging found upper cervical spondylosis without AAS or dynamic instability but with periodontoid calcifications and ossifications, suggesting calcium pyrophosphate dihydrate (CPPD) crystal deposition. Based on a comprehensive literature search and review, CPPD disease around the atlantodental joint is a possible contributor to secondary OA development and retro-odontoid pannus formation through chronic inflammation, which can be enough severe to induce compression myelopathy in non-RA patients without AAS. The global increase in the aged population advises caution regarding more prevalent upper cervical spine disorders associated with OA and CPPD.

Crystal Diseases of the Spine

“…It may lead to spinal cord compression and myelopathy. 35 On MRI, it appears hypointense on both T1-and T2-weighted images (►Fig. 6).…”

Periodontoid Pseudotumor with Respiratory Arrest

“…Periodontoid pseudotumor typically presents in elderly patients with a long-standing history of myelopathies, such as gait disturbance, fine motor skills disturbance, and numbness. [ 1 , 2 ] We present the first case of periodontoid pseudotumor with respiratory arrest.…”