Klineberg Eric, Bui Tuan, Schlenk Richard, Lieberman Isador
Department of Orthopaedic Surgery, University of California Davis School of Medicine, Sacramento, California, United States.
Department of Orthopaedics, Drexel University, Philadelphia, Pennsylvania, United States.
Evid Based Spine Care J. 2014 Apr;5(1):63-9. doi: 10.1055/s-0034-1370897.
Study Design Case report and review of the literature. Objective A retro-odontoid mass is a rare cause of cervical compression and myelopathy. The differential diagnosis includes the following: metastatic disease, primary tumor, collagen disorder, or inflammatory disease. Calcium pyrophosphate dihydrate (CPPD) deposition has been referred to as "crowned dens syndrome" when there are periodontoideal calcifications. There are only a few reported cases where CPPD presents as a cystic retro-odontoid mass in the atlanto-dens interval. In previous descriptions of surgical intervention, transoral resection of the mass is associated with significant morbidity and usually requires stabilization. The objective of this article is to report a case of an unusual presentation of CPPD disease of C1/C2, where we used a novel, minimally invasive surgical technique for decompression without fusion. Patients and Methods An 83-year-old female patient presented with progressive cervical myelopathy over a 3-month period. Computed tomography and magnetic resonance imaging demonstrated a cystic odontoid mass with a separate retro-odontoid compressive mass. A novel, minimally invasive transoral aspiration was performed. Histologic confirmation of CPPD was obtained. Results Postop imaging showed satisfactory decompression, which was maintained at the 6-month follow-up. This correlated with clinical improvement postop and 6-month follow-up. Conclusion CPPD in the atlanto-dens interval may present as a cystic retro-odontoideal mass and should be included in the differential. We used a transoral minimally invasive approach to aspirate the cyst. This novel technique avoided the need for a stabilization procedure or morbid transoral resection and provided excellent results immediately and at 6 months.
病例报告及文献综述。目的：齿突后肿物是导致颈椎受压和脊髓病的罕见原因。鉴别诊断包括以下几种：转移性疾病、原发性肿瘤、胶原紊乱或炎性疾病。当存在齿周钙化时，二水焦磷酸钙（CPPD）沉积被称为“齿突冠综合征”。仅有少数病例报告显示CPPD在寰枢椎间隙表现为囊性齿突后肿物。在以往关于手术干预的描述中，经口切除肿物会带来显著的并发症，且通常需要进行固定。本文的目的是报告一例C1/C2节段CPPD疾病的不寻常表现，我们采用了一种新颖的微创外科技术进行减压且无需融合。患者与方法：一名83岁女性患者在3个月内出现进行性颈椎脊髓病。计算机断层扫描和磁共振成像显示一个囊性齿突肿物以及一个单独的齿突后压迫性肿物。实施了一种新颖的微创经口抽吸术，并获得了CPPD的组织学证实。结果：术后影像学显示减压效果满意，在6个月随访时仍维持良好。这与术后及6个月随访时的临床改善情况相符。结论：寰枢椎间隙的CPPD可能表现为囊性齿突后肿物，应列入鉴别诊断范围。我们采用经口微创方法抽吸囊肿。这种新技术避免了进行固定手术或进行有创的经口切除，并且在即刻及6个月时均取得了优异的效果。
