Hypertrophy of the transverse ligament caused by os odontoideum: a case report

Year 2017, Volume: 11 Issue: 3, 149 - 152, 30.12.2017

Seda Avnioğlu , Vaner Köksal Tolga Ertekin

Abstract

Os odontoideum is a small oval or round shaped bone fragment observed as the most common congenital anomaly of the

odontoid process. Since it causes a slowly increasing mobility or instability in the atlanto-axial joint, sudden death, tetraplegia,

chronic neck pain, headache, torticollis and myelopathy may develop. The spinal canal widens initially at the craniocervical

junction and symptoms can occur at a very late stage. In this case, clinical complaints emerged after the age of 35.

There was no other neurological finding and no history of recent trauma in this case presenting with severe neck pain. This

case report shows how ligaments, the supporting connective tissue elements, can be thickened to maintain stability when

the stability of the cervical spine is impaired. Since it may cause sudden death even when asymptomatic, it is important to

recognize this pathology and to distinguish os odontoideum from odontoid fractures in trauma patients.

Keywords

anatomy; atlantoaxial dislocation; hypertrophy of the transverse ligament; instability; os odontoideum

References

• 1. Dlouhy BJ, Policeni BA, Menezes AH. Reduction of atlantoaxial dislocation prevented by pathological position of the transverse ligament in fixed, irreducible os odontoideum: operative illustrations and radiographic correlates in 41 patients. J Neurosurg Spine 2017; 27:20–8.
• 2. Moosa S, Andronikou S. Spastic quadraparesis following a relatively minor injury - the ‘os odontoideum’. South African Journal of Radiology 2006;10:34–6.
• 3. Dai L, Yuan W, Ni B, Jia L. Os odontoideum: etiology, diagnosis, and management. Surg Neurol 2000;53:106–8.
• 4. Galli J, Tartaglione T, Calo L, Ottaviani F. Os odontoideum in a patient with cervical vertigo: a case report. Am J Otolaryngol 2001; 22:371–3.
• 5. Akobo S, Rizk E, Loukas M, Chapman JR, Oskouian RJ, Tubbs RS. The odontoid process: a comprehensive review of its anatomy, embryology, and variations. Childs Nerv Syst 2015;31:2025–34.
• 6. Klimo P Jr, Coon V, Brockmeyer D. Incidental os odontoideum: current management strategies. Neurosurg Focus 2011;31:E10.
• 7. Kotil K. Os odontoideum. Turk Noroflirurji Dergisi 2015;2:170–6.
• 8. Yildiz A, Apayd›n FD, Özer C, E¤ilmez H, Duce MN, Yalç›no¤lu O. Kranyovertebral bölge ve servikal vertebra anomalileri. Diagnostic and Interventional Radiology 2001;7:38–42.
• 9. Kaya RA, Turkmeno¤lu O, Çavufloglu H, Kahyao¤lu O, Ayd›n Y. Os odontoideum: a case report. Turk Neurosurg 2005;15:157–61.
• 10. Tommy KY, Ratnayake K. Os odontoideum discovered after minor cervical trauma. Pediatr Emerg Care 2017;2:104–6.
• 11. Köksal V, Kayac› S, Coflkun S. Hangman fracture treated using cervical collar. Journal of Emergency Medicine Case Reports 2014;5: 127–130.
• 12. Candan B, Tomruk O, Yildiz O, Albay S. Dens fracture or odontoid bone. International Journal of Anatomical Variations 2014;7:14–6.
• 13. Rozzelle CJ, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Ryken TC, Theodore N, Walters BC, Hadley MN. Os odontoideum. Neurosurgery 2013;72:159–69.
• 14. Weng C, Tian W, Li ZY, Liu B, Li Q, Wang YQ, Sun YZ. Surgical management of symptomatic os odontoideum with posterior screw fixation performed using the magerl and harms techniques with intraoperative 3-dimensional fluoroscopy-based navigation. Spine (Phila Pa 1976) 2012;37:1839–46.
• 15. Fielding JW, Hensinger RN, Hawkins RJ. Os odontoideum. J Bone Joint Surg Am 1980;62:376–83.
• 16. Hukuda S, Ota H, Okabe N, Tazima K. Traumatic atlantoaxial dislocation causing os odontoideum in infants. Spine (Phila Pa 1976) 1980;5:207–10.
• 17. Fielding JW, Griffin PP. Os odontoideum: an acquired lesion. J Bone Joint Surg 1974;56:187–90.
• 18. Stevens JM, Chong WK, Barber C, Kendall BE, Crockard HA. A new appraisal of abnormalities of the odontoid process associated with atlanto-axial subluxation and neurological disability. Brain 1994;117: 133–48.
• 19. Yucesoy K, Yuksel M, Kalemci O, Yuksel KZ. Os odontoideumlu bir olgunun radyolojik görüntüleme bulgular› ve ay›r›c› tan›s›: olgu sunumu. Sinir Sistemi Cerrahisi Dergisi 2010;3:84–8.
• 20. Kirlew KA, Hathout GM, Reiter SD, Gold RH. Os odontoideum in identical twins: perspectives on etiology. Skeletal Radiol 1993;22: 525–7.
• 21. Morgan MK, Onofrio BM, Bender CE. Familial os odontoideum. Case report. J Neurosurg 1989;70:636–9.
• 22. Rahimizadeh A, Soufiani HF, Hassani V, Rahimizadeh A. Atlantoaxial subluxation due to an os odontoideum in an achondroplastic adult: report of a case and review of the literature. Case Rep Orthop 2015; 2015:142586.
• 23. Koksal V, Yavasi O. Controversies in the differential diagnosis of Brown-Sequard syndrome due to cervical spinal disease from stroke: a case series. Turk J Emerg Med 2017;17:115–20.
• 24. Spierings EL, Braakman R. The management of os odontoideum: analysis of 37 cases. J Bone Joint Surg Br 1982;64:422–8.
• 25. Liu H, Wang T, Wang H, Ding WY. Posterior decompression and internal fixation in treatment of hypertrophy of posterior longitudinal ligament at C1-2 level accompanied with lower cervical spinal stenosis: a case report. Medicine (Baltimore) 2016;95:e5600.
• 26. Karavelioglu E, Kacar E, Gonul Y, Eroglu M, Boyaci MG, Eroglu S, Unlu E, Ulasli AM. Ligamentum flavum thickening at lumbar spine is associated with facet joint degeneration: an MRI study. J Back Musculoskelet Rehabil 2016;29:771–7.
• 27. Fukuyama S, Nakamura T, Ikeda T, Takagi K. The effect of mechanical stress on hypertrophy of the lumbar ligamentum flavum. J Spinal Disord 1995;8:126–30.