• M N Hadley, B C Walters, P A Grabb, N M Oyesiku, G J Przybylski, D K Resnick, and T C Ryken.
• Neurosurgery. 2020 Feb 3; 50 (3 Suppl): S148-55.

DiagnosisStandardsThere is insufficient evidence to support diagnostic standards.GuidelinesThere is insufficient evidence to support diagnostic guidelines.OptionsPlain x-rays of the cervical spine (anteroposterior, open-mouth odontoid, and lateral) and plain dynamic lateral x-rays performed in flexion and extension are recommended. Tomography (computed or plain) and/or magnetic resonance imaging of the craniocervical junction may be considered.ManagementStandardsThere is insufficient evidence to support treatment standards.GuidelinesThere is insufficient evidence to support treatment guidelines.OptionsPatients with os odontoideum, either with or without C1--C2 instability, who have neither symptoms nor neurological signs may be managed with clinical and radiographic surveillance. Patients with os odontoideum, particularly with neurological symptoms and/or signs, and C1--C2 instability may be managed with posterior C1--C2 internal fixation and fusion. Postoperative halo immobilization as an adjunct to posterior internal fixation and fusion is recommended unless successful C1--C2 transarticular screw fixation and fusion can be accomplished. Occipitocervical fusion with or without C1 laminectomy may be considered in patients with os odontoideum who have irreducible cervicomedullary compression and/or evidence of associated occipitoatlantal instability. Transoral decompression may be considered in patients with os odontoideum who have irreducible ventral cervicomedullary compression.

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