Zhao Deng, Wang Shenglin, Passias Peter G, Wang Chao
*Orthopaedic Department, Peking University Third Hospital, Beijing, China; ‡Orthopaedic Department, Third People's Hospital of Chengdu/Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, China; §Division of Spinal Surgery, NYU Medical Center/Hospital for Joint Diseases, NYU School of Medicine, New York, New York.
Neurosurgery. 2015 May;76(5):514-21. doi: 10.1227/NEU.0000000000000668.
Our clinical understanding of os odontoideum (OO) remains incomplete. Congenital and traumatic causes have been proposed and advocated. Clinical presentations range from asymptomatic to axial pain to myelopathy or vertebral-basilar ischemia. A consensus for surgical management exists for those found to have an unstable atlantoaxial complex or symptomatic cranial-vertebral junction compression.
To evaluate the clinical presentation and surgical outcomes of patients with OO and an unstable atlantoaxial complex or symptomatic cranial-vertebral junction compression.
Patients with a diagnosis of OO who underwent surgical management were included. Patients were excluded on the basis of previous C2 fracture, Fielding diagnostic criteria, and inadequate follow-up. History of trauma and presenting symptoms were assessed. Clinical and neurological improvements were measured with the use of patient satisfaction scores and the Japanese Orthopaedic Association scores. Fusion status was documented with the use of radiographs and computed tomographic imaging.
Of 279 patients, 112 reported a history of cranial-vertebral junction trauma, whereas 28 were diagnosed with congenital malformations. Clinically, 84.9% of patients presented with myelopathy, with pain presented in 42.6%. Atlantoaxial fixation was performed in 240 patients, occiput-to-C2 fixation in 35 patients, and extended occipito-cervical fixation in 4 patients. Mean follow-up was 40.3 months. Complications were reported in 2.4% of patients. Japanese Orthopaedic Association scores improved from a preoperative mean of 12.4 to 14.8. Two hundred thirty-five patients (77.7%) improved, with 30 patients experiencing no change in symptoms and 14 patients deteriorating. Fusion was achieved in 96.8% of patients.
Our data reveal that surgical treatment for OO using the indications and techniques delineated is associated with high satisfaction rates, improved functional scores, and high fusion rates with low complication rates.
我们对齿突骨（OO）的临床认识仍不完整。先天性和创伤性病因已被提出并得到支持。临床表现从无症状到轴向疼痛，再到脊髓病或椎基底动脉缺血。对于那些被发现具有不稳定寰枢椎复合体或有症状的颅颈交界区受压的患者，手术治疗已达成共识。
评估患有OO且具有不稳定寰枢椎复合体或有症状的颅颈交界区受压患者的临床表现和手术效果。
纳入接受手术治疗的OO诊断患者。根据既往C2骨折、菲尔丁诊断标准和随访不充分排除患者。评估创伤史和现有的症状。使用患者满意度评分和日本骨科协会评分来衡量临床和神经功能的改善情况。通过X线片和计算机断层扫描成像记录融合状态。
279例患者中，112例报告有颅颈交界区创伤史，而28例被诊断为先天性畸形。临床上，84.9%的患者表现为脊髓病，42.6%的患者有疼痛症状。240例患者进行了寰枢椎固定，35例患者进行了枕骨至C2固定，4例患者进行了扩大枕颈固定。平均随访时间为40.3个月。2.4%的患者报告有并发症。日本骨科协会评分从术前平均12.4分提高到14.8分。235例患者（77.7%）症状改善，30例患者症状无变化，14例患者症状恶化。96.8%的患者实现了融合。
我们的数据表明，使用所描述的适应证和技术对OO进行手术治疗，患者满意度高、功能评分改善、融合率高且并发症发生率低。
