• Oscar L Alves, June Ho Lee, Djamel Kitumba, Agnaldo Lucas, Saleh Baeesa, Said Ben Ali, Francisco Sampaio, Gustavo Uriza, Ricardo Gepp, Mehmet Zileli, Ricardo Botelho, Jörg Klekamp, and Atul Goel.
• Department of Neurosurgery, Centro Hospitalar Gaia e Espinho, Portugal.
• Spine. 2025 Jan 29.

Study DesignA systematic literature review and consensus using Delphi method.ObjectiveThe aim was to formulate consensus recommendations regarding the natural history, diagnosis, classification and optimal treatment of Os Odontoideum with global applicability.Summary Of BackgroundOs odontoideum (OO) is a rare anomaly of the cranio-vertebral junction (CVJ). Due to the paucity of literature, there is still considerable debate about the clinical management of OO.Material And MethodUsing PubMed, the authors reviewed the literature on OO published from 2011 to 2022. Using the Delphi method, a panel expert spine surgeons and members of the WFNS Spine Committee analyzed the strength of the published literature, elaborated and voted statements concerning diagnosis and management.ResultThe diagnosis may be established incidentally. Symptoms may manifest as neck discomfort or encompass occipital-cervical pain, myelopathy, or vertebrobasilar ischemia. Diagnosis is usually made with plain radiographs and CT can. Dynamic x-rays identify C1-C2 instability whereas MRI assess spinal cord integrity and compression. Asymptomatic cases lacking radiologic instability are generally handled through regular observation and serial imaging, until predictors of neurological deterioration necessitate surgical intervention. In the event of atlantoaxial instability or neurological dysfunction, surgical intervention with instrumentation and fusion is required to maintain stability. In irreducible cases, C1-2 joint manipulation and distraction permits re-alignment and deformity correction avoiding decompression, either from anterior or posterior.ConclusionThe management guidelines for asymptomatic OO are still a grey zone as our understanding of the natural history is still vague. Therefore, we need more large-center studies to investigate this condition further. Whenever symptomatic, unstable or asymptomatic presenting with risk factors, OO is better managed with atlanto-axial fusion avoiding occipital inclusion in the construct. In irreducible OO, C1-2 joint manipulation and distraction is preferred to decompression.Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

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