Treatment of pediatric unstable os odontoideum with adjacent degenerative cyst: case presentation and literature review
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CASE REPORT
Treatment of pediatric unstable os odontoideum with adjacent degenerative cyst: case presentation and literature review Anthony M. Alvarado 1 & Joseph S. Domino 1 & Paul A. Grabb 1,2 & David M. Garcia 1,2 Received: 26 December 2019 / Accepted: 7 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Degenerative cysts associated with an unstable os odontoideum in pediatric patients are uncommon lesions. Reported treatments of such lesions have varied and yielded mixed results with the optimal surgical strategy remaining unclear. The authors report the clinical and surgical outcome of a 13-year-old patient presenting with degenerative cyst adjacent to an abnormal os odontoideum motion segment. The patient was asymptomatic from this lesion which was an incidental finding while undergoing workup for atypical headaches. Clinical and radiologic findings, operative details, and postoperative outcome are described. The patient was successfully treated with posterior cervical fusion without direct cyst decompression. Complete resolution of the cyst was demonstrated on magnetic resonance imaging at 6 months. Computed tomography 8 months postoperatively showed solid bony fusion and normal alignment. Regarding treatment goals in pediatric patients with os odontoideum degenerative cysts, the current case and literature review supports posterior instrumented fusion without direct surgical cyst resection. Keywords Atlantoaxial fusion . C1-2 arthrodesis . Degenerative cyst . Os odontoideum
Abbreviations CT Computed tomography MRI Magnetic resonance imaging OO Os odontoideum
Introduction Os odontoideum (OO) is an anomaly of the second cervical vertebrae characterized by separation of a portion of the odontoid process (dens) from the body of the axis. Two main etiological theories exist for OO formation including an embryologic origin due to fusion abnormality and a traumatic origin [1–3]. Extraosseous cystic lesions in the setting of OO are rare entities and can be incidental findings, or manifest with signs and symptoms of cervical myelopathy due to spinal canal compromise [2, 4]. The pathogenesis of synovial cysts is thought to be a
degenerative process due to excessive joint mobility [2, 4, 5]. Cystic lesions associated with OO create a conundrum since it is a joint that should not exist. Treatment options vary widely for these lesions, including both surgical and nonsurgical methods. Operative techniques reported include posterior, anterior transoral, and combined approaches. Percutaneous and conservative treatments have also been utilized [6, 7]. Instability correction alone has been utilized to allow for cyst resorption and ensuing decompression of the spinal cord [2, 4, 8]. The clinical rarity of OO-associated degenerative cysts makes determination of the optimal management difficult. Pediatric retro-odontoid cystic lesions have only been described twice in a literature review, both occurring in the setting of unstable atlantoaxial movement [8, 9]. The medical literature review
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