Title

Os Odontoideum in Children: Treatment Outcomes and Neurological Risk Factors.

Document Type

Article

Publication Date

10-2-2019

Identifier

DOI: 10.2106/JBJS.19.00314

Abstract

BACKGROUND: Treatment outcomes and risk factors for neurological deficits in pediatric patients with an os odontoideum are unclear.

METHODS: We reviewed the data for 102 children with os odontoideum who were managed at 11 centers between 2000 and 2016 and had a minimum duration of follow-up of 2 years. Thirty-one children had nonoperative treatment, and 71 underwent instrumented posterior cervical spinal arthrodesis for the treatment of C1-C2 instability. Nonoperative treatment consisted of observation (n = 29) or immobilization with a cervical collar (n = 1) or halo body jacket (n = 1). Surgical treatment consisted of atlantoaxial (n = 50) or occipitocervical (n = 21) arthrodesis. One patient also underwent transoral odontoidectomy.

RESULTS: Thirty children (29%) presented with neurological deficits, 28 of whom had radiographic atlantoaxial instability (atlantoaxial distance >5 mm) or limited space (≤13 mm) available for the spinal cord (risk ratio, 7.8 [95% confidence interval, 2.0 to 31] compared with children with no radiographic risk factors). The 27 children without neurological deficits or atlantoaxial instability at presentation underwent nonoperative treatment and remained asymptomatic. Of the initial nonoperative cohort, one child developed atlantoaxial instability, and another had a persistent neurological deficit; both children underwent spinal arthrodesis during the study period. One child with cervical instability declined surgery and remained asymptomatic. Spinal fusion occurred in 68 patients in the surgical group by the end of the study period (mean, 3.7 years; range, 2.0 to 11.8 years). Surgical complications occurred in 21 children, including nonunion in 12, new neurological deficits in 4, cerebrospinal fluid leak in 2, symptomatic instrumentation requiring removal 2, and vertebral artery injury in 1. Nine children underwent revision surgery. In the surgical group, Japanese Orthopaedic Association neurological function scores improved significantly from preoperatively to the latest follow-up for the upper extremities (p = 0.026) and lower extremities (p = 0.007).

CONCLUSIONS: The risk of developing a neurological deficit was strongly associated with atlantoaxial instability and limited space available for the spinal cord in children with os odontoideum. Nonoperative treatment was safe for asymptomatic patients without atlantoaxial instability. Spinal arthrodesis resolved the neurological deficits of children with symptomatic os odontoideum.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Journal Title

The Journal of bone and joint surgery. American volume

Volume

101

Issue

19

First Page

1750

Last Page

1760

MeSH Keywords

Adolescent; Atlanto-Axial Joint; Axis, Cervical Vertebra; Braces; Child; Child, Preschool; Humans; Immobilization; Infant; Joint Instability; Neck Pain; Nervous System Diseases; Risk Factors; Spinal Cord Injuries; Spinal Fusion; Treatment Outcome; Watchful Waiting

Keywords

Adolescent; Atlanto-Axial Joint; Axis, Cervical Vertebra; Braces; Child; Child, Preschool; Humans; Immobilization; Infant; Joint Instability; Neck Pain; Nervous System Diseases; Risk Factors; Spinal Cord Injuries; Spinal Fusion; Treatment Outcome; Watchful Waiting

Share

COinS