Top

Surgical and Radiologic Anatomy

Published in:

01-02-2020 | Spinal Stenosis | Medical Imaging

Os odontoideum: diagnosis and role of imaging

Authors: Qing Wang, Shuai Dong, Fang Wang

Published in: Surgical and Radiologic Anatomy | Issue 2/2020

Abstract

Objective

To elucidate the imaging manifestations of os odontoideum, establish the diagnosis and guide surgical therapy.

Methods

Clinical and imaging data, including X-ray, CT and MR of 24 patients with os odontoideum, were retrieved and reviewed retrospectively.

Results

Os odontoideum with intact cortex was divided into round, conical and blunt tooth types. Four cases of orthotopic and 20 cases of dystopic os odontoideum were included. There was anterior displacement of the base of the dens in six cases, posterior displacement in nine cases and no displacement in nine cases. A widening of anterior atlanto-axial space was shown in 14 patients with varying degrees. Thickening of the soft tissue posterior to the dens was observed in 19 patients, spinal canal stenosis in 21 patients, cervical myelopathy in 10 patients and craniocervical junction malformation in 9 patients. Posterior C1–C2 pedicle screw fixation and fusion was performed in 12 patients and 4 patients underwent posterior occipito-cervical fixation and fusion.

Conclusion

Radiographically, os odontoideum is defined as an independent ossicle of variable size with smooth circumferential cortical margins separated from the axis. Imaging can be used to assess atlanto-axial instability, associated normal or abnormal anatomical structures and guide surgical therapy.

Akobo S, Rizk E, Loukas M et al (2015) The odontoid process: a comprehensive review of its anatomy, embryology, and variations. Childs Nerv Syst 31:2025–2034. https://doi.org/10.1007/s00381-015-2866-4 CrossRefPubMed

Arvin B, Fournier-Gosselin MP, Fehlings MG (2010) Os odontoideum: etiology and surgical management. Neurosurgery 66:22–31. https://doi.org/10.1227/01.NEU.0000366113.15248.07 CrossRefPubMed

Chatterjee S, Karmakar PS, Mitra R et al (2013) Sudden onset quadriparesis after minor injury to neck in a male with os odontoideum. J Assoc Physicians India 61:138–139

Choit RL, Jamieson DH, Reilly CW (2005) Os odontoideum: a significant radiographic finding. Pediatr Radiol 35:803–807. https://doi.org/10.1007/s00247-005-1448-0 CrossRefPubMed

Currarino G (2002) Segmentation defect in the midodontoid process and its possible relationship to the congenital type of os odontoideum. Pediatr Radiol 32:34–40. https://doi.org/10.1007/s00247-001-0579-1 CrossRefPubMed

Dias RP, Buchanan CR, Thomas N et al (2016) Os odontoideum in Wolcott-Rallison syndrome: a case series of 4 patients. Orphanet J Rare Dis 1:1–5. https://doi.org/10.1186/s13023-016-0397-z CrossRef

Giacomini C (1886) Sull’esistenza dell’“os odontoideum”nell’uomo. Gior Accad MedTorino 49:24–28

Johal J, Loukas M, Fisahn C et al (2016) Bergmann’s ossicle (ossiculum terminale persistens): a brief review and differentiation from other findings of the odontoid process. Childs Nerv Syst 32:1603–1606. https://doi.org/10.1007/s00381-016-3199-7 CrossRefPubMed

Jumah F, Alkhdour S, Mansour S et al (2017) Os odontoideum: a comprehensive clinical and surgical review. Cureus 9:1551.e1–1551.e8. https://doi.org/10.7759/cureus.1551 CrossRef

10.

Jun BY (1999) Complete reduction of retro-odontoid soft tissue mass in os odontoideum following the posterior C1–C2 transarticular screw fixation. Spine 24:1961–1964. https://doi.org/10.1097/00007632-199909150-00017 CrossRefPubMed

11.

Kanai M, Kijima K, Shirahata E et al (2005) Odontoid compression of the brainstem without basilar impression—“odontoid invagination”. J Clin Neurosci 12:565–569. https://doi.org/10.1016/j.jocn.2004.07.022 CrossRef

12.

Kim TY, Ratnayake K (2017) Os odontoideum discovered after minor cervical trauma. Pediatr Emerg Care 33:104–106. https://doi.org/10.1097/PEC.0000000000000945 CrossRefPubMed

13.

Klimo P Jr, Coon V, Brockmeyer D (2011) Incidental os odontoideum: current management strategies. Neurosurg Focus 31:246–247. https://doi.org/10.3171/2011.9.FOCUS11227 CrossRef

14.

Korres DS, Chytas DG, Markatos KN et al (2017) The “challenging” fractures of the odontoid process: a review of the classification schemes. Eur J Orthop Surg Traumatol 127:469–475. https://doi.org/10.1007/s00590-016-1895-3 CrossRef

15.

Montemurro N, Perrini P, Mangini V et al (2019) The Y-shaped trabecular bone structure in the odontoid process of the axis: a CT scan study in 54 healthy subjects and biomechanical considerations. J Neurosurg Spine 1:1–8. https://doi.org/10.3171/2018.9.SPINE18396 CrossRef

16.

Nguyen JC, Pollock AN (2015) Os odontoideum. Pediatr Emerg Care 31:225–227. https://doi.org/10.1097/PEC.0000000000000411 CrossRefPubMed

17.

Perrini P, Montemurro N, Iannelli A (2013) The contribution of Carlo Giacomini (1840–1898): the Limbus Giacomini and beyond. Neurosurgery 72:475–481. https://doi.org/10.1227/NEU.0b013e31827fcda3 CrossRefPubMed

18.

Sankar WN, Wills BP, Dormans JP et al (2006) Os odontoideum revisited: the case for a multifactorial etiology. Spine 31:979–984. https://doi.org/10.1097/01.brs.0000214935.70868.1c CrossRefPubMed

19.

Sardi JP, Iwanaga J, Oskouian RJ et al (2017) First gross anatomic findings of an os odontoideum. World Neurosurg 101:813.e1–813.e3. https://doi.org/10.1016/j.wneu.2017.03.066 CrossRef

20.

Spierings EL, Braakman R (1982) The management of os odontoideum. Analysis of 37 cases. J Bone Jt Surg Br 64:422–428. https://doi.org/10.1097/01.brs.0000214935.70868.1c CrossRef

21.

Wang S, Wang C (2011) Familial dystopic os odontoideum. J Bone Jt Surg Am 93A:893. https://doi.org/10.2106/JBJS.J.01018 CrossRef

22.

Zhang Z, Wang H, Chao L (2014) Acute traumatic cervical cord injury in pediatric patients with os odontoideum: a series of 6 patients. World Neurosurg 83:1180.e1–1180.e6. https://doi.org/10.1016/j.wneu.2014.12.036 CrossRef

23.

Zhang Z, Zhou Y, Wang J et al (2010) Acute traumatic cervical cord injury in patients with os odontoideum. J Clin Neurosci 17:1289–1293. https://doi.org/10.1016/j.jocn.2010.01.051 CrossRefPubMed

Title: Os odontoideum: diagnosis and role of imaging
Authors: Qing Wang
Shuai Dong
Fang Wang
Publication date: 01-02-2020
Publisher: Springer Paris
Keyword: Spinal Stenosis
Published in: Surgical and Radiologic Anatomy / Issue 2/2020
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-019-02351-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Os odontoideum: diagnosis and role of imaging

Abstract

Objective

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2020

Spine and dura-mater: from lumbar pedicle to skull basis

A digital anatomic investigation of the safe triangle areas for L1–5 percutaneous minimally invasive discectomy

The relationship between density variations of transverse ligament tubercles on multidetector computed tomography (MDCT) and age, gender, or laterality in a large cohort

Carotid-anterior cerebral artery (ACA) anastomosis associated with azygos ACA and ophthalmic artery arising from the middle meningeal artery: a case report

Tethered cord syndrome and transitional vertebrae

Reply to Liu’s Letter to the Editor regarding the article: “Frequency, location, and morphology of accessory maxillary sinus ostia: a retrospective study using cone beam computed tomography (CBCT)”