Korean J Neurotrauma.  2016 Oct;12(2):180-184. 10.13004/kjnt.2016.12.2.180.

Retro-Odontoid Pseudotumor without Atlantoaxial Subluxation or Rheumatic Arthritis

• Yu SH
• Choi HJ
• Cho WH
• Cha SH
• Han IH

• KMID: 2356798
• DOI: http://doi.org/10.13004/kjnt.2016.12.2.180

Abstract

We present a case of retro-odontoid pseudotumor (ROP) without rheumatoid arthritis (RA) or atlantoaxial subluxation (AAS). A 76-year-old woman presented with paresthesia and weakness of both lower and upper extremities. She had no laboratory or physical findings of RA. Dynamic X-ray showed no AAS and magnetic resonance imaging (MRI) showed a retro-odontoid mass compressing the spinal cord. Transdural mass debulking and biopsy were performed via minimal left suboccipital craniectomy and C1 hemilaminectomy. Two months after surgery, her symptoms were aggravated. Follow-up MRI visualized mass re-growth and spinal cord compression due to the mass and AAS. Posterior C1-2 fixation was performed without further decompression. Twelve months after posterior fixation, no symptoms were apparent and follow-up MRI showed complete resolution of the ROP with C1-2 bony fusion. The ROP with C1-2 instability might be completely resolved only C1-2 fusion without decompression. Furthermore, we speculated that osteoarthritis of C1-2 itself causes a partial tear or degradation of the transverse ligament, that induced formation of ROP.

Keyword

Odontoid process; Atlanto-axial joint; Arthritis, rheumatoid; Osteoarthritis

MeSH Terms

Aged
Arthritis, Rheumatoid
Atlanto-Axial Joint
Biopsy
Decompression
Female
Follow-Up Studies
Humans
Ligaments
Magnetic Resonance Imaging
Odontoid Process
Osteoarthritis
Paresthesia
Rheumatic Fever*
Spinal Cord
Spinal Cord Compression
Tears
Upper Extremity

Figure

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  FIGURE 1 Dynamic flexion cervical radiographs (A) and extension (B) showing no evidence of atlantoaxial subluxation.

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  FIGURE 2 A magnetic resonance imaging showing retro-odontoid pannus compressing the spinal cord, that appears as an area of mixed intensity on sagittal T2-weighted image (arrow).

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  FIGURE 3 A 3-dimention cervical computed tomography scan showing spondylotic change of whole cervical spine.

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  FIGURE 4 Postoperative cervical spine computed tomography showing hemilaminectomy of C1 and debulked the retro-odontoid mass (A). Postoperative (2 months later) magnetic resonance imaging (MRI) showing remnant retro-odontoid mass (B). After posterior C1-2 fixation surgery, follow magnetic resonance imaging (C) showing no evidence of retro-odontoid mass.

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