![]() The most common causes include rheumatoid arthritis (RA), acute trauma, and congenital abnormalities such as Down syndrome, Morquoi Syndrome, and neurofibromatosis. Pseudotumor formation can be secondary to a variety of etiologies. Surgeons have been shifting towards minimally invasive approaches, including use of endoscopy and upper cervical spinal fusion and laminectomy for indirect decompression. However, there existed a significant risk for complications, including cerebrospinal fluid (CSF) leakage and postoperative infections. Following its initial discovery, suggested treatment was through a transoral approach for direct removal and decompression of the pannus. Anderson and D’Alonzo first classified odontoid fractures associated with pannus formation into 3 types in 1974. Retro-odontoid pseudotumor, or odontoid pannus, refers to a disease process characterized by non-neoplastic soft tissue proliferation that is adjacent to the odontoid process of cervical 2 (C2) vertebra, and can lead to compression of the vital neuronal structures of the cervicomedullary region. Finally, we will examine the role of external orthoses as both a method of conservative treatment as well as a potential adjunct to the aforementioned surgical procedures. ![]() Surgical techniques that are addressed include ventral decompression (both transoral and transnasal), dorsal decompression, and indications for posterior instrumentation in pannus formation, particularly in cases that may be sufficiently treated in lieu of an anterior approach. Additionally, we discuss past and current operative techniques designed to curtail and ultimately regress a retro-odontoid pseudotumor and pannus. We address the pathophysiology involved in acquired and congenital pseudotumor formation, including those associated with rheumatoid arthritis (panni). The objective of this review is to consolidate the findings in published case reports and relevant prior literature reviews regarding the formation of retro-odontoid pseudotumor. A pseudotumor may impinge on the spinal nerves or even the spinal cord and brainstem, manifesting symptoms from severe neck pain to cervicomedullary compression or myelopathy, and in some cases even sudden death. This instability can occur as a result of conditions ranging from severe mechanical trauma to metabolic disease or autoimmune conditions such as rheumatoid arthritis. ![]() Retro-odontoid pseudotumor formation consists of an abnormal growth of granulation tissue typically posterior to the odontoid process, resulting as a manifestation of atlantoaxial instability. ![]()
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