1127 - Cervical myelopathy due to a retro-odontoid pannus

Case Diagnosis: Cervical myelopathy due to retro-odontoid pannus

Case Description: A 75-year-old female with a past medical history of diabetes, hypertension, hyperlipidemia, atrial fibrillation, right below the knee amputation, and chronic neck and back pain, presented to the hospital with a headache and worsening paresthesia and weakness in her bilateral upper extremities. MRI showed severe C1-2 stenosis with a large retro-odontoid pannus formation compression cord with cord signal change. On flexion/extension x-ray imaging, there was instability demonstrated at the C1-2 level. Patient ultimately had a C1-2 fusion and a C1 laminectomy. Patient discharged to acute rehab and she was diagnosed with a spinal cord injury (SCI) level of C1 ASIA D. Over 2.5 weeks, patient made significant functional improvement including transfers, car transfer, wheelchair use, shower/toileting, and dressing. Patient was safely discharged home.

Discussions: Cervical myelopathy due to a retro-odontoid pannus is an uncommon pathophysiology.  When diagnosed, it is typically observed in patients previously diagnosed with rheumatoid arthritis, trauma, or cancer. To our knowledge, our patient had none of these comorbidities and presented with a spontaneous retro-odontoid pannus. Per literature review, there has only been one other case report of a spontaneous retro-odontoid pannus. Regardless of etiology, prompt surgical treatment to decompress the spinal cord and rehabilitating the patient is key to maintaining or regaining functional outcome.

Conclusions:

Cervical myelopathy due to spontaneous retro-odontoid pannus is very rare. With proper workup and treatment in a timely manner, patients with this rare condition can rehabilitate and maintain functional independence.