Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
Neurosurgery. 2010 Mar;66(3 Suppl):22-31. doi: 10.1227/01.NEU.0000366113.15248.07.
Os odontoideum is an independent ossicle of variable size with smooth circumferential cortical margins separated from the foreshortened odontoid peg. The etiology of os odontoideum remains controversial, but there is now emerging consensus on the traumatic etiology of os odontoideum rather than a congenital source.
We reviewed the literature of os odontoideum. Patients with this condition can be asymptomatic or present with wide range of neurological dysfunctions. Although the diagnosis of os odontoideum can be made with plain x-rays, further imaging modalities including magnetic resonance imaging and computed tomography angiography have improved the preoperative planning.
There is a role for conservative treatment of an asymptomatic incidentally found, radiologically stable, and noncompressive os odontoideum. Conversely, surgery has a definite role in symptomatic cases. The main method of surgical treatment today is posterior decompression after reduction and fusion via independent C1 and C2 instrumentation. Irreducible, persistent anterior compression from os odontoideum can be approached by a transoral route with good results in experienced hands.
齿状突骨是一种大小不一的独立骨块，具有光滑的环形皮质边缘，与缩短的齿状突钉分离。齿状突骨的病因仍存在争议，但现在越来越多的人认为齿状突骨是创伤性的，而不是先天性的。
我们回顾了齿状突骨的文献。患有这种疾病的患者可以没有症状，也可以表现出广泛的神经功能障碍。虽然平片可以诊断齿状突骨，但进一步的成像方式，包括磁共振成像和计算机断层血管造影，已经改善了术前规划。
对于无症状、影像学稳定且无压迫的齿状突骨，可以采用保守治疗。相反，手术对有症状的病例有明确的作用。目前手术治疗的主要方法是通过独立的 C1 和 C2 器械进行复位和融合后的后路减压。在有经验的手中，对于无法复位、持续的前向压迫的病例，可以采用经口入路，取得良好的效果。
