Skip to main content
SpringerLink
Log in

Post-operative regression of retro-odontoid pseudotumors treated with and without fusion

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Retro-odontoid pseudotumor is common in elderly people and is a cause of cervical myelopathy. The goal of the study was to investigate surgical procedures, outcomes, and post-operative spontaneous regression of posterior cervical retro-odontoid pseudotumors.

Methods

The subjects were 29 patients who underwent surgery for myelopathy due to a retro-odontoid pseudotumor around the craniocervical region at 9 facilities and were followed-up for an average of 54 months (range 12–96 months). Data were collected in a multicenter review of a retrospective database. Comparisons were performed between cases treated with and without fusion.

Results

The JOA recovery rate at final follow-up did not differ significantly between the fusion (n = 17, including all 15 patients with atlantoaxial subluxation) and non-fusion (n = 12) groups. However, pseudotumor regression was significantly more frequent in the fusion group (100% vs. 42%, p < 0.01). In all patients, regression cases had significantly higher rates of contrast enhancement of the pseudotumor on pre-operative T1 gadolinium-enhanced MRI (68% vs. 14%, p = 0.013) and of JOA recovery (50% vs. 30%, p < 0.01).

Conclusions

Regression of pseudotumor occurred in all cases treated with fusion surgery. There was a significant difference in pseudotumor regression with or without fusion, and regression was significantly related to gadolinium enhancement on MRI. Therefore, it is preferable to use fusion surgery for a retro-odontoid pseudotumor that shows contrast enhancement, even if there is no apparent instability pre-operatively.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Yamaguchi I, Shibuya S, Arima N et al (2006) Remarkable reduction or disappearance of retroodontoid pseudotumors after occipitocervical fusion. Report of three cases. J Neurosurg Spine 5:156–160

    Article  Google Scholar 

  2. Kakutani K, Doita M, Yoshikawa M et al (2013) C1 laminectomy for retro-odontoid pseudotumor without atlantoaxial subluxation: review of seven consecutive cases. Eur Spine J 22:1119–1126

    Article  Google Scholar 

  3. Sze G, Brant-Zawadzki MN, Wilson CR et al (1986) Pseudotumor of the craniovertebral junction associated with chronic subluxation: MR imaging studies. Radiology 161:391–394

    Article  CAS  Google Scholar 

  4. Isono M, Ishii K, Kamida T et al (2001) Retro-odontoid soft tissue mass associated with atlantoaxial subluxation in an elderly patient: a case report. Surg Neurol 55:223–227

    Article  CAS  Google Scholar 

  5. Tanaka S, Nakada M, Hayashi Y et al (2010) Retro-odontoid pseudotumor without atlantoaxial subluxation. J Clin Neurosci 17:649–652

    Article  Google Scholar 

  6. Crockard HA, Sett P, Geddes JF et al (1991) Damaged ligaments at the craniocervical junction presenting as an extradural tumour: a differential diagnosis in the elderly. J Neurol Neurosurg Psychiatry 54:817–821

    Article  CAS  Google Scholar 

  7. Chikuda H, Seichi A, Takeshita K et al (2009) Radiographic analysis of the cervical spine in patients with retro-odontoid pseudotumors. Spine 34:E110–E114

    Article  Google Scholar 

  8. Kosaka E, Ishihara H, Osada R et al (2002) Periodontoid pannus migration into the spinal canal with reduction of rheumatoid atlantoaxial subluxation: a case report. J Orthop Sci 7:703–706

    Article  Google Scholar 

  9. Rousselin B, Helenon O, Zingraff J et al (1990) Pseudotumor of the craniocervical junction during long-term hemodialysis. Arthritis Rheum 33:1567–1573

    Article  CAS  Google Scholar 

  10. Oohori Y, Seichi A, Kawaguchi H et al (2004) Retroodontoid pseudotumor resected by a high cervical lateral approach in a rheumatoid arthritis patient: a case report. J Orthop Sci 9:90–93

    Article  Google Scholar 

  11. Fransen P, Pizzolato GP, Otten P et al (1997) Synovial cyst and degeneration of the transverse ligament: an unusual cause of high cervical myelopathy. J Neurosurg 86:1027–1030

    Article  CAS  Google Scholar 

  12. Grob D, Würsch R, Grauer W et al (1997) Atlantoaxial fusion and retrodental pannus in rheumatoid arthritis. Spine 22:1580–1583

    Article  CAS  Google Scholar 

  13. Yoshida K, Hanyu T, Takahashi HE (1999) Progression of rheumatoid arthritis of the cervical spine: radiographic and clinical evaluation. J Orthop Sci 4:399–406

    Article  CAS  Google Scholar 

  14. Takami T, Goto T, Tsuyuguchi N et al (2007) Posterior C1–2 fixation with cancellous screw and rod system for retro-odontoid pseudotumor associated with chronic atlantoaxial subluxation. Neurol Med Chir (Tokyo) 47:189–193

    Article  Google Scholar 

  15. Tominaga F, Shirasawa K, Yamashita A et al (2015) Operation for retro-odontoid pseudotumor. Seikei-geka 66:311–314 [in Japanese]

    Google Scholar 

  16. Yonezawa I, Okuda T, Won J et al (2013) Retrodental mass in rheumatoid arthritis. J Spinal Disord Tech 26:E65–E69

    Article  Google Scholar 

  17. Igarashi T, Hayashi M, Shibuya J et al (2015) Retroodontoid pseudotumor increased after cervical spinal decompression: a case report. Tohokuseisaishi 57:114–118

    Google Scholar 

  18. White AA, Panjabi MM (1990) Clinical biomechanism of the spine, 2nd edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  19. Japanese Orthopaedic Association (1994) Scoring system for cervical myelopathy. J Jpn Orthop Assoc 68:490–530 [in Japanese]

    Google Scholar 

  20. Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Article  CAS  Google Scholar 

  21. Shah A, Jain S, Kaswa A et al (2016) Immediate postoperative disappearance of retro-odontoid “pseudotumor”. World Neurosurg 91:419–423

    Article  Google Scholar 

  22. Bydon M, Macki M, Qadi M et al (2015) Regression of an atlantoaxial rheumatoid pannus following posterior instrumented fusion. Clin Neurol Neurosurg 137:28–33

    Article  Google Scholar 

  23. Finn M, Fassett DR, Apfelbaum RI (2007) Surgical treatment of nonrheumatoid atlantoaxial degenerative arthritis producing pain and myelopathy. Spine 32:3067–3073

    Article  Google Scholar 

  24. Marks RJ, Forrester PC, Calder I et al (1986) Anaesthesia for transoral craniocervical surgery. Anaesthesia 41:1049–1052

    Article  CAS  Google Scholar 

  25. Sukoff MH, Kadin MM, Moran T (1972) Transoral decompression for myelopathy caused by rheumatoid arthritis of the cervical spine. J Neurosurg 37:493–497

    Article  CAS  Google Scholar 

  26. Arima H, Murata H, Hasegawa T et al (2013) Treatment of retro-odontoid pseudotumor. Report of five cases. Rinsyo Seikei-geka 48:81–85 [in Japanese]

    Google Scholar 

  27. Barbagallo GM, Certo F, Visocchi M et al (2013) Disappearance of degenerative, non-inflammatory, retro-odontoid pseudotumor following posterior C1–C2 fixation: case series and review of the literature. Eur Spine J 22(Suppl 6):879–888

    Article  Google Scholar 

  28. Sono T, Onishi E, Matsushita M (2014) Radiographic risk factors and surgical outcomes for retroodontoid pseudotumors. J Spinal Disord Tech 27:E193–E198

    Article  Google Scholar 

  29. Takemoto M, Neo M, Fujibayashi S et al (2016) Clinical and radiographic outcomes of c1 laminectomy without fusion in patients with cervical myelopathy that is associated with a retro-odontoid pseudotumor. Clin Spine Surg 29:E514–E521

    Article  Google Scholar 

  30. Wakatsuki T, Matsusaki M, Tanaka N et al (2016) Myelopathy recurrence by retro-odontoid cyst after atlas laminectomy for retro-odontoid pseudotumor: report of a case. Seikei-geka 67:243–246 [in Japanese]

    Google Scholar 

  31. Suetsuna F, Narita H, Ono A et al (2006) Regression of retroodontoid pseudotumors following C-1 laminoplasty. Report of three cases. J Neurosurg Spine 5:455–460

    Article  Google Scholar 

  32. Bouvet JP, le Parc JM, Michalski B et al (1985) Acute neck pain due to calcifications surrounding the odontoid process: the Crowned Dens Syndrome. Arthritis Rheum 28:1417–1420

    Article  CAS  Google Scholar 

  33. Wu DW, Reginato AJ, Torriani M et al (2005) The Crowned Dens Syndrome as a cause of neck pain: report of two new cases and review of the literature. Arthritis Rheum 53:133–137

    Article  Google Scholar 

Download references

Funding

Funding was from institutional sources only.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan

    Kazuyoshi Kobayashi, Shiro Imagama, Kei Ando, Yoshihiro Nishida & Naoki Ishiguro

  2. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Aichi, 466-8550, Japan

    Shiro Imagama

Authors
  1. Kazuyoshi Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shiro Imagama
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kei Ando
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshihiro Nishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Naoki Ishiguro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shiro Imagama.

Ethics declarations

Conflict of interest

None of the authors have a conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 1524 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kobayashi, K., Imagama, S., Ando, K. et al. Post-operative regression of retro-odontoid pseudotumors treated with and without fusion. Eur Spine J 27, 3105–3112 (2018). https://doi.org/10.1007/s00586-018-5573-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-018-5573-5

Keywords

Search

Navigation