Neurospine.  2021 Mar;18(1):67-78. 10.14245/ns.2040402.201.

Retro-Odontoid Pseudotumor Formation in the Context of Various Acquired and Congenital Pathologies of the Craniovertebral Junction and Surgical Techniques

  • 1Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
  • 2Western University of Health Sciences College of Osteopathic Medicine, Pomona, CA, USA
  • 3University of Pikeville, Kentucky College of Osteopathic Medicine, Pikeville, KY, USA
  • 4Alabama College of Osteopathic Medicine, Dothan, AL, USA
  • 5New York Institute of Technology College of Osteopathic Medicine, Glen Head, NY, USA
  • 6Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA


Retro-odontoid pseudotumor formation consists of an abnormal growth of granulation tissue typically posterior to the odontoid process, resulting as a manifestation of atlantoaxial instability. This instability can occur as a result of conditions ranging from severe mechanical trauma to metabolic disease or autoimmune conditions such as rheumatoid arthritis. A pseudotumor may impinge on the spinal nerves or even the spinal cord and brainstem, manifesting symptoms from severe neck pain to cervicomedullary compression or myelopathy, and in some cases even sudden death. The objective of this review is to consolidate the findings in published case reports and relevant prior literature reviews regarding the formation of retro-odontoid pseudotumor. We address the pathophysiology involved in acquired and congenital pseudotumor formation, including those associated with rheumatoid arthritis (panni). Additionally, we discuss past and current operative techniques designed to curtail and ultimately regress a retro-odontoid pseudotumor and pannus. Surgical techniques that are addressed include ventral decompression (both transoral and transnasal), dorsal decompression, and indications for posterior instrumentation in pannus formation, particularly in cases that may be sufficiently treated in lieu of an anterior approach. Finally, we will examine the role of external orthoses as both a method of conservative treatment as well as a potential adjunct to the aforementioned surgical procedures.


Pseudotumor; Pannus; Craniocervical junction; Cervical spine; Retro-odontoid; Odontoid
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