Immediate postoperative regression of retroodontoid pannus after lateral mass reconstruction in a patient with rheumatoid disease of the craniovertebral junction

Case report

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The authors report the case of a 35-year-old man who had polyarthritic affliction with rheumatoid disease. He presented with complaints of quadriparesis that had progressed over the course of 2 years. Investigations revealed telltale evidence of rheumatoid disease of the craniovertebral junction with retroodontoid pannus, basilar invagination, and “fixed” atlantoaxial dislocation. The patient underwent lateral mass reconstruction with distraction of the facets and impaction of a spiked metal spacer and bone graft within the joint. Investigations done in the immediate postoperative phase showed complete disappearance of retroodontoid pannus in addition to reduction of basilar invagination and atlantoaxial dislocation. He had remarkable and sustained relief from symptoms. The authors also review the pathogenesis and treatment of retroodontoid pannus.

Abbreviation used in this paper:CVJ = craniovertebral junction.

Article Information

Address correspondence to: Atul Goel, M.Ch., Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial Hospital, Parel, Mumbai 400 012, India. email: atulgoel62@hotmail.com.

© AANS, except where prohibited by US copyright law.

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    Preoperative images. A: A CT scan showing atlantoaxial dislocation and mild basilar invagination. B: Sagittal T2-weighted MR image showing retroodontoid pannus, a lax posterior spinal ligament, and evidence of cord compression. C: Sagittal T1-weighted MR image showing the retroodontoid pannus and cord compression.

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    Postoperative images. A: A CT scan showing reduction in the atlantoaxial dislocation and basilar invagination. B: Sagittal reconstructed CT scan showing the spacer impacted within the atlantoaxial joint. C: Coronal reconstructed CT scan showing the spacers within both the atlantoaxial joints. D: Sagittal T2-weighted MR image showing complete regression of the retroodontoid pannus and the stretched normal posterior spinal ligament. Craniospinal realignment can be observed. E: Sagittal T1-weighted MR image showing the regression of the pannus.

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