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Disappearance of degenerative, non-inflammatory, retro-odontoid pseudotumor following posterior C1–C2 fixation: case series and review of the literature

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Abstract

Purpose

Retro-odontoid pseudotumor, not related to inflammatory or traumatic conditions, is an uncommon pathology. Atlanto-axial instability has been advocated to explain the pathophysiology of retro-odontoid pseudotumor’s formation and growth. Despite pseudotumor direct removal through transoral or lateral approach represented the main surgical strategy for a long time, in the last decade several authors highlighted the possibility to treat retro-odontoid pseudotumor by occipito-cervical or C1–C2 fixation without removal of the intracanalar tissue. The goal of this study is to analyze the data collected in a series of patients suffering from cervical myelopathy due to non-inflammatory, degenerative retro-odontoid pannus and treated by posterior C1–C2 fixation. The relevant literature is also reviewed.

Methods

Five patients, not suffering from inflammatory diseases, were treated between 2009 and 2012. Abnormalities of cranio-cervical junction and/or lower cervical spondylotic degeneration were observed in all patients. No evidence of atlanto-axial instability was demonstrated. Clinical and radiological evaluation included pre- and post-operative Nurick score as well as pre- and post-operative X-rays, CT and MRI. In one case, CT scan highlighted an eggshell calcification of the pannus. All patients underwent either a C1–C2 fixation (C1 lateral mass and C2 isthmus-pedicle screws) or occipito-cervical fixation (2 patients) in cases of C0–C1 fusion.

Results

Follow-up ranges from 22 to 45 months (mean 32) in four patients. One patient died of surgery-unrelated disease. Nurick score changes suggest a clinical improvement in four cases. Neuro-radiological evaluation shows a progressive but incomplete reduction of thickness of retro-odontoid pseudotumor in one patient, and its disappearance in the other three cases. A second-stage transoral or posterior lateral approach was not required.

Conclusion

Although the etiopathogenesis of non-inflammatory, i.e., degenerative, retro-odontoid pseudotumor is still controversial, our series (the second largest on degenerative retro-odontoid pannus in the literature) confirms that a posterior approach may be sufficient and transoral surgery is not required.

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Acknowledgments

The authors declare that no funding has been or will be received from any grant-giving organization in conjunction with the generation of this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Policlinico “G. Rodolico” University Hospital, Viale XX Settembre 45, 95129, Catania, Italy

    Giuseppe M. V. Barbagallo, Francesco Certo, Giovanni Sciacca & Vincenzo Albanese

  2. Department of Radiology, Policlinico “G. Rodolico” University Hospital, Catania, Italy

    Stefano Palmucci

  3. Institute of Neurosurgery, Catholic University, Rome, Italy

    Massimiliano Visocchi

Authors
  1. Giuseppe M. V. Barbagallo
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Correspondence to Giuseppe M. V. Barbagallo.

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Barbagallo, G.M.V., Certo, F., Visocchi, M. et al. Disappearance of degenerative, non-inflammatory, retro-odontoid pseudotumor following posterior C1–C2 fixation: case series and review of the literature. Eur Spine J 22 (Suppl 6), 879–888 (2013). https://doi.org/10.1007/s00586-013-3004-1

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