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.
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.
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).
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.
These slides can be retrieved under Electronic Supplementary Material.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
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
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
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
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
Tanaka S, Nakada M, Hayashi Y et al (2010) Retro-odontoid pseudotumor without atlantoaxial subluxation. J Clin Neurosci 17:649–652
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
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
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
Rousselin B, Helenon O, Zingraff J et al (1990) Pseudotumor of the craniocervical junction during long-term hemodialysis. Arthritis Rheum 33:1567–1573
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
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
Grob D, Würsch R, Grauer W et al (1997) Atlantoaxial fusion and retrodental pannus in rheumatoid arthritis. Spine 22:1580–1583
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
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
Tominaga F, Shirasawa K, Yamashita A et al (2015) Operation for retro-odontoid pseudotumor. Seikei-geka 66:311–314 [in Japanese]
Yonezawa I, Okuda T, Won J et al (2013) Retrodental mass in rheumatoid arthritis. J Spinal Disord Tech 26:E65–E69
Igarashi T, Hayashi M, Shibuya J et al (2015) Retroodontoid pseudotumor increased after cervical spinal decompression: a case report. Tohokuseisaishi 57:114–118
White AA, Panjabi MM (1990) Clinical biomechanism of the spine, 2nd edn. Lippincott Williams & Wilkins, Philadelphia
Japanese Orthopaedic Association (1994) Scoring system for cervical myelopathy. J Jpn Orthop Assoc 68:490–530 [in Japanese]
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
Shah A, Jain S, Kaswa A et al (2016) Immediate postoperative disappearance of retro-odontoid “pseudotumor”. World Neurosurg 91:419–423
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
Finn M, Fassett DR, Apfelbaum RI (2007) Surgical treatment of nonrheumatoid atlantoaxial degenerative arthritis producing pain and myelopathy. Spine 32:3067–3073
Marks RJ, Forrester PC, Calder I et al (1986) Anaesthesia for transoral craniocervical surgery. Anaesthesia 41:1049–1052
Sukoff MH, Kadin MM, Moran T (1972) Transoral decompression for myelopathy caused by rheumatoid arthritis of the cervical spine. J Neurosurg 37:493–497
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]
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
Sono T, Onishi E, Matsushita M (2014) Radiographic risk factors and surgical outcomes for retroodontoid pseudotumors. J Spinal Disord Tech 27:E193–E198
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
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]
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
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
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
Funding was from institutional sources only.
Conflict of interest
None of the authors have a conflict of interest.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
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
- Retro-odontoid pseudotumor
- Atlantoaxial instability
- Occipitocervical fusion
- Posterior decompression
- Spinal fusion
- Gadolinium-enhanced MRI