Retro-odontoid calcium pyrophosphate dehydrate deposition: surgical management and review of the literature.
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.
Department of Orthopaedic Surgery, University of California Davis School of Medicine, Sacramento, California, United States.
Eric
E
Klineberg
Department of Orthopaedics, Drexel University, Philadelphia, Pennsylvania, United States.
Tuan
T
Bui
Cleveland Clinic Foundation, Cleveland, Ohio, United States.
Richard
R
Schlenk
Scoliosis and Spine Tumor Center, Texas Back Institute, Plano, Texas, United States.
Isador
I
Lieberman
calcium pyrophosphate dihydrate; cervical decompression; cervical mass aspiration; cervical myelopathy; crowned dens syndrome; crystal deposition disease; retro-odontoid mass