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Treatment of pediatric unstable os odontoideum with adjacent degenerative cyst: case presentation and literature review

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Abstract

Degenerative cysts associated with an unstable os odontoideum in pediatric patients are uncommon lesions. Reported treatments of such lesions have varied and yielded mixed results with the optimal surgical strategy remaining unclear. The authors report the clinical and surgical outcome of a 13-year-old patient presenting with degenerative cyst adjacent to an abnormal os odontoideum motion segment. The patient was asymptomatic from this lesion which was an incidental finding while undergoing workup for atypical headaches. Clinical and radiologic findings, operative details, and postoperative outcome are described. The patient was successfully treated with posterior cervical fusion without direct cyst decompression. Complete resolution of the cyst was demonstrated on magnetic resonance imaging at 6 months. Computed tomography 8 months postoperatively showed solid bony fusion and normal alignment. Regarding treatment goals in pediatric patients with os odontoideum degenerative cysts, the current case and literature review supports posterior instrumented fusion without direct surgical cyst resection.

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Abbreviations

CT:

Computed tomography

MRI:

Magnetic resonance imaging

OO:

Os odontoideum

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Correspondence to Joseph S. Domino.

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Alvarado, A.M., Domino, J.S., Grabb, P.A. et al. Treatment of pediatric unstable os odontoideum with adjacent degenerative cyst: case presentation and literature review. Childs Nerv Syst (2020). https://doi.org/10.1007/s00381-020-04533-6

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Keywords

  • Atlantoaxial fusion
  • C1-2 arthrodesis
  • Degenerative cyst
  • Os odontoideum