Yurube Takashi, Iguchi Tetsuhiro, Kinoshita Keisuke, Sadamitsu Takashi, Kakutani Kenichiro
Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Orthopedic Surgery, Saiseikai Hyogo Prefecture Hospital, Kobe, Japan.
Neurospine. 2021 Dec;18(4):903-913. doi: 10.14245/ns.2142112.056. Epub 2021 Dec 31.
The retro-odontoid pseudotumor is often concurrent with atlantoaxial subluxation (AAS). Therefore, the pseudotumor is relatively common in rheumatoid arthritis (RA) but rare in primary osteoarthritis (OA). This is a case report of an elderly male patient suffering from neck pain and compression myelopathy caused by the craniocervical pseudotumor with OA but without atlantoaxial instability. He had long-lasting peripheral and spinal pain treated by nonsteroidal anti-inflammatory drugs. Imaging found upper cervical spondylosis without AAS or dynamic instability but with periodontoid calcifications and ossifications, suggesting calcium pyrophosphate dihydrate (CPPD) crystal deposition. Based on a comprehensive literature search and review, CPPD disease around the atlantodental joint is a possible contributor to secondary OA development and retro-odontoid pannus formation through chronic inflammation, which can be enough severe to induce compression myelopathy in non-RA patients without AAS. The global increase in the aged population advises caution regarding more prevalent upper cervical spine disorders associated with OA and CPPD.
齿突后假瘤常与寰枢椎半脱位（AAS）并发。因此，该假瘤在类风湿关节炎（RA）中相对常见，而在原发性骨关节炎（OA）中罕见。本文报告了一例老年男性患者，患有由颅颈假瘤伴OA引起的颈部疼痛和脊髓压迫症，但无寰枢椎不稳。他长期存在外周和脊柱疼痛，接受非甾体类抗炎药治疗。影像学检查发现存在无AAS或动态不稳的上颈椎骨质增生，但有齿突周围钙化和骨化，提示焦磷酸钙二水合物（CPPD）晶体沉积。基于全面的文献检索和综述，寰齿关节周围的CPPD疾病可能通过慢性炎症导致继发性OA发展和齿突后血管翳形成，这种炎症严重程度足以在无AAS的非RA患者中诱发脊髓压迫症。老年人口的全球增长提示，对于与OA和CPPD相关的更普遍的上颈椎疾病应谨慎对待。
