Skip Navigation

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (27)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Stevens, J. M.
Right arrow Articles by Crockard, H. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Stevens, J. M.
Right arrow Articles by Crockard, H. A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Brain, Vol. 117, No. 1, 133-148, 1994
© 1994 Oxford University Press

research-article

A new appraisal of abnormalities of the odontoid process associated with atlanto-axial subluxation and neurological disability

John M. Stevens1,, W. Kling Chong1, Christopher Barber1, Brian E. Kendall1 and H. Alan Crockard2

1Departments of Neuroradiology, The National Hospitals for Neurology and Neurosurgery Maida Vale, London, UK 2Departments of Surgical Neurology, The National Hospitals for Neurology and Neurosurgery Maida Vale, London, UK

Correspondence to: Correspondence to: Dr John Stevens, Consultant Neuroradiotogist, The National Hospitals for Neurology and Neurosurgery, Maida Vale, London W9 1TL, UK

It is well known that abnormalities of the odontoid process may be associated with subluxation and neuraxial compression. Modern computerized imaging is demonstrating that existing classifications are in need of revision since they no longer reflect current views on development, nor do they adequately explain the patterns of abnormality commonly encountered in clinical practice. This study is a description of 62 varied clinical cases examined by high definition computerized myelography or MRI in flexion and extension, some before and after stabilization procedures. From these descriptions, and a review of the old and more recent literature concerning phylogenesis and ontogenesis of the odontoid, the following conclusions were drawn. The dens within the atlas ring is not morphologically a centrum of the first cervical vertebra, but a projection arising from it. In os odontoideum the dens forms normally, but ossifies abnormally because of abnormal motion; it is a result rather than the cause of instability. Hypoplasia of the dens is usually incorrectly diagnosed. When present it is associated with atlanto-occipital assimilation, fusion of the second and third, or more, cervical vertebrae, loss or reduction in axial rotation of the head, basilar invagination and hindbrain deformity of Chiari type. Therefore it is part of a regional anomaly involving hypoplasia of the derivatives of the occipital and upper cervical somites. Recognition of these aspects simplifies both diagnosis and the formulation of therapeutic strategies for different types of clinical presentation.

odontoid; congenital malformations; trauma

Received June 24, 1993. Revised September 14, 1993. Accepted November 12, 1993.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 J. Neurol. Neurosurg. PsychiatryHome page
S J Chawda, A Munchau, D Johnson, K Bhatia, N P Quinn, J Stevens, A J Lees, and J D Palmer
Pattern of premature degenerative changes of the cervical spine in patients with spasmodic torticollis and the impact on the outcome of selective peripheral denervation
J. Neurol. Neurosurg. Psychiatry, April 1, 2000; 68(4): 465 - 471.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.