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Evid Based Spine Care J 2014; 05(01): 063-069
DOI: 10.1055/s-0034-1370897
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Retro-Odontoid Calcium Pyrophosphate Dehydrate Deposition: Surgical Management and Review of the Literature

Eric Klineberg
1   Department of Orthopaedic Surgery, University of California Davis School of Medicine, Sacramento, California, United States
,
Tuan Bui
2   Department of Orthopaedics, Drexel University, Philadelphia, Pennsylvania, United States
,
Richard Schlenk
3   Cleveland Clinic Foundation, Cleveland, Ohio, United States
,
Isador Lieberman
4   Scoliosis and Spine Tumor Center, Texas Back Institute, Plano, Texas, United States
› Author Affiliations
Further Information

Publication History

13 May 2013

18 December 2013

Publication Date:
28 March 2014 (online)

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Abstract

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.

Keywords

crowned dens syndrome - calcium pyrophosphate dihydrate - retro-odontoid mass - cervical myelopathy - crystal deposition disease - cervical decompression - cervical mass aspiration
 

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