Evaluation of the Bone Union Occurring Subsequent to C1-2 Fusion Combined With C1 Laminectomy for the Surgical Treatment of Retro-Odontoid Pseudotumor

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Jul 30

PMID 39077223

Authors

Kosei Ono

Sohei Murata

Mutsumi Matsushita

Yu Shimizu

Yusuke Nakamura

Taisuke Yabe

Hiromu Ito

Affiliations

Soon will be listed here.

Abstract

Introduction Surgical treatments for retro-odontoid pseudotumors (ROPs) include C1 laminectomies and C1-2 and occipitocervical (OC) fusions. When a C1 laminectomy is combined with a C1-2 fusion, concerns arise regarding an increased risk of pseudarthrosis due to decreased bone grafting space. Extension of the fusion area to the OC region may be considered to ensure an adequate bone graft bed. However, this procedure is associated with a risk of complications. Thus, in this study, we investigated the bone fusion and clinical outcomes of C1-2 fusion combined with a C1 laminectomy. Methods Between January 2017 and December 2022, seven patients with ROPs who had undergone C1-2 fusion combined with a C1 laminectomy were included in the study. All patients were followed up for >1 year. Bone fusion was evaluated by computed tomography (CT) at one year postoperatively, while implant failure was assessed by radiography at the final follow-up. Clinical evaluations included preoperative and one-year postoperative Japanese Orthopaedic Association (JOA) scores and recovery rates. Results This study included five male and two female patients, with an average age of 71.9 years. The average follow-up duration was 3.3 years. The primary anchor choices included the C1 lateral mass screw and the C2 pedicle screw. In one case, the transarticular screw was utilized unilaterally, and in another case, a lamina screw was utilized unilaterally. One year postoperatively, CT revealed bone fusion in three of the seven patients. Fusion occurred at the lateral and median atlantoaxial joints in two cases and one case, respectively. Screw loosening was observed in one case. None of the patients required reoperations. The average JOA recovery rate was 34.6%. Conclusion This surgical technique is useful for stabilizing and decompressing the C1-2 region while preserving mobility at the OC joint. However, further long-term follow-up studies are required.

References

Izeki M, Neo M, Takemoto M, Fujibayashi S, Ito H, Nagai K . The O-C2 angle established at occipito-cervical fusion dictates the patient's destiny in terms of postoperative dyspnea and/or dysphagia. Eur Spine J. 2013; 23(2):328-36. PMC: 3906459. DOI: 10.1007/s00586-013-2963-6. View

Yonezawa I, Okuda T, Won J, Sakoda J, Nakahara D, Nojiri H . Retrodental mass in rheumatoid arthritis. J Spinal Disord Tech. 2012; 26(2):E65-9. DOI: 10.1097/BSD.0b013e3182621a05. View

Zygmunt S, Saveland H, Brattstrom H, Ljunggren B, Larsson E, Wollheim F . Reduction of rheumatoid periodontoid pannus following posterior occipito-cervical fusion visualised by magnetic resonance imaging. Br J Neurosurg. 1988; 2(3):315-20. DOI: 10.3109/02688698809001001. View

Barbagallo G, Certo F, Visocchi M, Palmucci S, Sciacca G, Albanese V . Disappearance of degenerative, non-inflammatory, retro-odontoid pseudotumor following posterior C1-C2 fixation: case series and review of the literature. Eur Spine J. 2013; 22 Suppl 6:S879-88. PMC: 3830051. DOI: 10.1007/s00586-013-3004-1. View

Sono T, Onishi E, Matsushita M . Radiographic risk factors and surgical outcomes for retroodontoid pseudotumors. J Spinal Disord Tech. 2013; 27(6):E193-8. DOI: 10.1097/BSD.0b013e318299f4d8. View

Crockard H, Sett P, Geddes J, Stevens J, Kendall B, PRINGLE J . Damaged ligaments at the craniocervical junction presenting as an extradural tumour: a differential diagnosis in the elderly. J Neurol Neurosurg Psychiatry. 1991; 54(9):817-21. PMC: 1014523. DOI: 10.1136/jnnp.54.9.817. View

Park J, Lee E, Lee J, Kang Y, Ahn J, Yeom J . Postoperative Regression of Retro-odontoid Pseudotumor After Atlantoaxial Posterior Fixation: 11 Years of Experience in Patients With Atlantoaxial Instability. Spine (Phila Pa 1976). 2017; 42(23):1763-1771. DOI: 10.1097/BRS.0000000000002222. View

Takami M, Yukawa Y, Noda Y, Yoshida M, Yamada H . Salvage Surgery for Symptomatic Recurrence of Retro-Odontoid Pseudotumor after a C1 Laminectomy. Acta Med Okayama. 2022; 76(6):749-754. DOI: 10.18926/AMO/64127. View

Naderi S, Crawford N, Song G, Sonntag V, Dickman C . Biomechanical comparison of C1-C2 posterior fixations. Cable, graft, and screw combinations. Spine (Phila Pa 1976). 1998; 23(18):1946-55; discussion 1955-6. DOI: 10.1097/00007632-199809150-00005. View

10.

Yamagata T, Takami T, Naito K, Ohata K . C2 nerve root resection to achieve safe and wide exposure of lateral atlantoaxial joints in posterior C1-2 instrumented fixation: technical note. Neurol Med Chir (Tokyo). 2013; 53(12):914-9. PMC: 4508734. DOI: 10.2176/nmc.tn2012-0288. View

11.

Lehman Jr R, Dmitriev A, Helgeson M, Sasso R, Kuklo T, Riew K . Salvage of C2 pedicle and pars screws using the intralaminar technique: a biomechanical analysis. Spine (Phila Pa 1976). 2008; 33(9):960-5. DOI: 10.1097/BRS.0b013e31816c915b. View

12.

Shimizu T, Otsuki B, Fujibayashi S, Kumamoto S, Hijikata Y, Shimizu Y . Incidence and Risk Factors of Anterior Arch Fracture of the Atlas Following C1 Laminectomy Without Fusion. Spine (Phila Pa 1976). 2017; 43(10):667-674. DOI: 10.1097/BRS.0000000000002402. View

13.

Grob D, Wursch R, Grauer W, Sturzenegger J, Dvorak J . Atlantoaxial fusion and retrodental pannus in rheumatoid arthritis. Spine (Phila Pa 1976). 1997; 22(14):1580-3; discussion 1584. DOI: 10.1097/00007632-199707150-00010. View

14.

Yamaguchi I, Shibuya S, Arima N, Oka S, Kanda Y, Yamamoto T . Remarkable reduction or disappearance of retroodontoid pseudotumors after occipitocervical fusion. Report of three cases. J Neurosurg Spine. 2006; 5(2):156-60. DOI: 10.3171/spi.2006.5.2.156. View

15.

Jun B . Complete reduction of retro-odontoid soft tissue mass in os odontoideum following the posterior C1-C2 tranarticular screw fixation. Spine (Phila Pa 1976). 1999; 24(18):1961-4. DOI: 10.1097/00007632-199909150-00017. View

16.

Rousselin B, Helenon O, Zingraff J, DELONS S, Drueke T, Bardin T . Pseudotumor of the craniocervical junction during long-term hemodialysis. Arthritis Rheum. 1990; 33(10):1567-73. DOI: 10.1002/art.1780331015. View

17.

Sze G, Brant-Zawadzki M, Wilson C, Norman D, Newton T . Pseudotumor of the craniovertebral junction associated with chronic subluxation: MR imaging studies. Radiology. 1986; 161(2):391-4. DOI: 10.1148/radiology.161.2.3763907. View

18.

Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K . Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976). 1981; 6(4):354-64. DOI: 10.1097/00007632-198107000-00005. View

19.

Pettersson H, Larsson E, Holtas S, CRONQVIST S, Egund N, Zygmunt S . MR imaging of the cervical spine in rheumatoid arthritis. AJNR Am J Neuroradiol. 1988; 9(3):573-7. PMC: 8332823. View

20.

Ito H, Neo M, Fujibayashi S, Miyata M, Yoshitomi H, Nakamura T . Atlantoaxial transarticular screw fixation with posterior wiring using polyethylene cable: facet fusion despite posterior graft resorption in rheumatoid patients. Spine (Phila Pa 1976). 2008; 33(15):1655-61. DOI: 10.1097/BRS.0b013e31817b5c07. View