Abstract
A retro odontoid pseudo tumor is a mass lesion lying posterior to the odontoid process along the dura. It is a disease process seen in inflammatory and non-inflammatory conditions causing chronic atlanto-axial instability. This type of mass has the potential to enlarge causing cervicomedullary compression and symptoms of myelopathy. In the past, authors have relied on a more invasive, direct approach to decompress the mass including an anterior trans oral odontoidectomy and a posterior trans-dural resection. The objective of this case report is to describe the use of an indirect approach, cervical fusion with decompressive laminectomy, to successfully treat a retro odontoid pseudo tumor in a geriatric patient. A male patient in his late 90’s presented with inability to ambulate, global paresis, and long tract signs in the upper extremities. He was found to have a large odontoid mass with compression at the cranio-cervical junction. He underwent cervical fusion with instrumented fixation from C1-6 and decompressive laminectomy from C4-6. Over a follow-up period of two years, there was improvement in the patient’s motor weakness and ambulation. Radiographic evaluation at the two-year mark showed marked reduction in pannus size. Indirect approaches to decompression in patients with retro odontoid pseudo tumor using techniques such as cervical fusion may be a safe for effective treatment in patients of advanced age, with multiple co-morbidities, and inability to tolerate lengthy surgical procedures.
Highlights
Retro odontoid pseudo tumor is a disease entity characterized by a mass lesion lying posterior to the odontoid process and resting along the dural sheath outside of the spinal cord
Retro odontoid pseudo tumors or odontoid pannus is a disease process characterized by formation of a posterior mass with possible cystic formation, which may lead to marked compression on vital neuronal structures at the cervicocranial junction
Certain risk factors have been associated with an odontoid pannus including rheumatoid arthritis, Os odontoideum, or malunion of odontoid fracture
Summary
Retro odontoid pseudo tumor is a disease entity characterized by a mass lesion lying posterior to the odontoid process (the upward protuberance of the C2 vertebrae, or dens) and resting along the dural sheath outside of the spinal cord This retro odontoid mass may be referred to as an odontoid pannus or phantom tumor.[1] Over time, it may enlarge, causing cervicomedullary compression due to proximity to the spinal cord at the level where the cervical spinal cord and brainstem meet. This may lead to myelopathy, a clinical syndrome defined by neurologic deficit arising from the spinal cord. In rare instances (as seen in this case), there may be development of pannus-related cysts leading to further compression of the upper spinal cord and lower medulla
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