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Os Odontoideum: Analysis of 190 Surgically Treated Cases.
World Neurosurg. 2020 Feb; 134:e512-e523.WN

Abstract

OBJECTIVE

The aim of this study was to report an experience with 190 cases of os odontoideum over 20 years. The management outcome following atlantoaxial fixation was analyzed.

METHODS

From January 2000 to September 2018, 190 patients with os odontoideum were surgically treated. There were 113 male patients and 77 female patients; average age was 24 years (range, 2-68 years).The patients were divided into 3 groups depending on the nature of atlantoaxial dislocation (group 1, mobile and partially or completely reducible atlantoaxial dislocation; group 2, fixed or irreducible atlantoaxial dislocation; group 3, presence of basilar invagination). There were 65 pediatric patients (<18 years old). All patients underwent atlantoaxial joint manipulation and lateral mass plate and screw fixation. The goal of surgery was segmental atlantoaxial arthrodesis. No transoral or posterior foramen magnum bone decompression was done. Occipital bone was not included in the fixation construct.

RESULTS

On direct bone handling and observation, atlantoaxial joint pathologic hyperactivity related instability was identified in all patients. Atlantoaxial segmental stabilization resulted in clinical symptomatic and neurologic improvement in 100% of patients.

CONCLUSIONS

Os odontoideum signifies chronic or long-standing atlantoaxial instability. Segmental atlantoaxial fixation is a reliable form of surgical treatment. Bone decompression is not necessary. Inclusion of occipital bone and subaxial vertebrae in the fixation construct is not necessary.

Authors+Show Affiliations

Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India; Lilavati Hospital and Research Centre, Bandra, Mumbai, India. Electronic address: atulgoel62@hotmail.com.Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India.Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India.Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India.Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India.Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31669688

Citation

Goel, Atul, et al. "Os Odontoideum: Analysis of 190 Surgically Treated Cases." World Neurosurgery, vol. 134, 2020, pp. e512-e523.
Goel A, Patil A, Shah A, et al. Os Odontoideum: Analysis of 190 Surgically Treated Cases. World Neurosurg. 2020;134:e512-e523.
Goel, A., Patil, A., Shah, A., Dandpat, S., Rai, S., & Ranjan, S. (2020). Os Odontoideum: Analysis of 190 Surgically Treated Cases. World Neurosurgery, 134, e512-e523. https://doi.org/10.1016/j.wneu.2019.10.107
Goel A, et al. Os Odontoideum: Analysis of 190 Surgically Treated Cases. World Neurosurg. 2020;134:e512-e523. PubMed PMID: 31669688.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Os Odontoideum: Analysis of 190 Surgically Treated Cases. AU - Goel,Atul, AU - Patil,Abhinandan, AU - Shah,Abhidha, AU - Dandpat,Saswat, AU - Rai,Survendra, AU - Ranjan,Shashi, Y1 - 2019/10/26/ PY - 2019/09/07/received PY - 2019/10/17/revised PY - 2019/10/18/accepted PY - 2019/11/2/pubmed PY - 2020/3/17/medline PY - 2019/11/1/entrez KW - Atlantoaxial fixation KW - Atlantoaxial instability KW - Basilar invagination KW - Os odontoideum SP - e512 EP - e523 JF - World neurosurgery JO - World Neurosurg VL - 134 N2 - OBJECTIVE: The aim of this study was to report an experience with 190 cases of os odontoideum over 20 years. The management outcome following atlantoaxial fixation was analyzed. METHODS: From January 2000 to September 2018, 190 patients with os odontoideum were surgically treated. There were 113 male patients and 77 female patients; average age was 24 years (range, 2-68 years).The patients were divided into 3 groups depending on the nature of atlantoaxial dislocation (group 1, mobile and partially or completely reducible atlantoaxial dislocation; group 2, fixed or irreducible atlantoaxial dislocation; group 3, presence of basilar invagination). There were 65 pediatric patients (<18 years old). All patients underwent atlantoaxial joint manipulation and lateral mass plate and screw fixation. The goal of surgery was segmental atlantoaxial arthrodesis. No transoral or posterior foramen magnum bone decompression was done. Occipital bone was not included in the fixation construct. RESULTS: On direct bone handling and observation, atlantoaxial joint pathologic hyperactivity related instability was identified in all patients. Atlantoaxial segmental stabilization resulted in clinical symptomatic and neurologic improvement in 100% of patients. CONCLUSIONS: Os odontoideum signifies chronic or long-standing atlantoaxial instability. Segmental atlantoaxial fixation is a reliable form of surgical treatment. Bone decompression is not necessary. Inclusion of occipital bone and subaxial vertebrae in the fixation construct is not necessary. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/31669688/Os_Odontoideum:_Analysis_of_190_Surgically_Treated_Cases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(19)32735-4 DB - PRIME DP - Unbound Medicine ER -