• Antti J Saarinen, Jennifer M Bauer, Bram Verhofste, Paul D Sponseller, Walter F Krengel, Daniel Hedequist, Patrick J Cahill, A Noelle Larson, Joshua M Pahys, Jeffrey E Martus, Burt Yaszay, Jonathan H Phillips, and Ilkka J Helenius.
• Department of Paediatric Orthopaedic Surgery, Turku University Hospital, Turku, Finland; Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland. Electronic address: antti.j.saarinen@utu.fi.
• World Neurosurg. 2021 Mar 1; 147: e324-e333.

ObjectiveThe outcomes of conservative and operative treatment of os odontoideum in children remain unclear. Our objective was to study the outcomes of conservative and surgical treatment of idiopathic os odontoideum in children and compare these outcomes in age- and treatment-matched nonidiopathic children with os odontoideum.MethodsA retrospective multicenter review identified 102 children with os odontoideum, of whom 44 were idiopathic with minimum 2-year follow-up. Ten patients were treated conservatively, and 34 underwent spinal arthrodesis. Both groups were matched with nonidiopathic patients by age and type of treatment. Cervical arthrodesis was recommended for patients with increased atlantoaxial distance or reduced space available for the cord in flexion-extension radiographs.ResultsAll 20 children undergoing conservative treatment remained asymptomatic during follow-up, but 1 nonidiopathic patient developed cervical instability. The idiopathic group had significantly less severe radiographic cervical instability and less neurologic complications than the nonidiopathic group (P < 0.05 for all comparisons). Thirty-three (97%) patients in the idiopathic group and 32 (94%) patients in the nonidiopathic group (94%) had spinal fusion at final follow-up (P = 0.55). The risk of complications (15% vs. 41%; odds ratio 0.234, 95% confidence interval 0.072-0.757, P = 0.015) and nonunion (6% vs. 24%; odds ratio 0.203, 95% confidence interval 0.040-0.99, P = 0.040) were significantly lower in the idiopathic than in the nonidiopathic group. Idiopathic children undergoing rigid fixation achieved spinal fusion.ConclusionsIdiopathic patients with stable atlantoaxial joint at presentation remained asymptomatic and intact during conservative treatment. Idiopathic children with os odontoideum undergoing spinal arthrodesis had significantly fewer complications and nonunion than nonidiopathic children.Level Of EvidenceIII.Copyright © 2020 Elsevier Inc. All rights reserved.

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