Retro-Odontoid Pseudotumor Formation in the Context of Various Acquired and Congenital Pathologies of the Craniovertebral Junction and Surgical Techniques
Fiani Brian, Houston Rebecca, Siddiqi Imran, Arshad Mohammad, Reardon Taylor, Gilliland Brandon, Davati Cyrus, Kondilis Athanasios,
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( Fiani Brian )
Desert Regional Medical Center Department of Neurosurgery
( Houston Rebecca )
Desert Regional Medical Center Department of Neurosurgery
( Siddiqi Imran )
Western University of Health Sciences College of Osteopathic Medicine
( Arshad Mohammad )
Desert Regional Medical Center Department of Neurosurgery
( Reardon Taylor )
University of Pikeville Kentucky College of Osteopathic Medicine
( Gilliland Brandon )
Alabama College of Osteopathic Medicine
( Davati Cyrus )
New York Institute of Technology College of Osteopathic Medicine
( Kondilis Athanasios )
Michigan State University College of Osteopathic Medicine
Abstract
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.
키워드
Pseudotumor; Pannus; Craniocervical junction; Cervical spine; Retro-odontoid; Odontoid
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