Retro-odontoid pseudotumor concomitant with proximal adjacent cervical spondylotic myelopathy after multilevel anterior cervical discectomy and fusion.

Abstract

Introduction and importanceAdjacent cervical spondylotic myelopathy (CSM) following anterior cervical discectomy and fusion (ACDF) presenting as a retro-odontoid pseudotumor (ROP) is uncommon. This consequence adversely affects hand function, causes gait imbalance and results in other disabilities for the patient. This report describes the successful surgical treatment of a patient with ROP associated with adjacent CSM following multilevel ACDF of the subaxial cervical vertebrae by performing posterior cervical decompression and fusion.Case presentationA 60-year-old-male presented with progressive, disabling cervical myelopathy. He had undergone ACDF C3-C7 for treatment of CSM 16 years ago and his symptoms had fully resolved. Magnetic resonance imaging (MRI) revealed severe cervical spinal cord compression caused by a retro-odontoid mass at the C1-C2 level with upper adjacent segment disease (ASD) of C1-C3. The patient received C1-C3 posterior cervical spinal fusion by C1 lateral mass C2 and C3 pedicle screw fixation and C1-C3 laminectomy. After the surgery, he was able to ambulate independently and the myelopathic symptoms were significantly improved at the 6 months follow-up.Clinical discussionRetro-odontoid pseudotumor concomitant with proximal ASD following ACDF is a rare occurrence. Both diagnosis and surgical management are challenging.ConclusionsPosterior cervical decompression and fusion of C1-C3 is an effective option for treatment of severe cervical spinal cord compression by a retro-odontoid mass at the C1-C2 level combined with ASD after ACDF.