The Study: Varied clinical presentation of os odontoideum: a case report.
- The purpose of the article was, To present a case of os odontoideum and to provide insight into the various clinical presentatoins."
- The patient was 54 years of age and suffered from chronic neck pain. They had been involved in a motor vehicle accident in the 1970s and another one in the 1980s. They did not seek medical care after either accident.
- Physical examination and A-P and later cervical radiographs were obtained.
- The patient was diagnosed as having grade II mechanical neck pain and received manipulation/mobilization.
- The clinician requested MRI and flexion and extension radiographs which had been taken previously by another provider in 2009.
- When the reports of the MRI and flexion and extension views came in they "described the presence of an os odontoideum."
- The patient was advised that they would not receive any more spinal manipulations due to the condition and was referred to a medical provider.
- Imaging is necessary to diagnose an os odontoideum.
- Some patients who have os odontoideum will be asymptomatic.
- In one study 64% of the cases with os odontoideum had neck pain. However, there is a high percentage of neck pain in the general population and the lack of prospective studies in this area make it difficult to make a link between neck pain and os odontiodeum.
- "...the association between os odontiodeum and headache is unclear."
- Although there is debate, the evidence indicates that the majority of cases have a traumatic etiology.
- The condition is associated with Down syndrome, Klippel-Feil syndrome, Morquio's disease, multiple epiphyseal dysplasia, pseudoachondroplasis, achondroplasia, Larson syndrome, and chondrodystrophia calcificans."
- Patients may be asymptomatic but may also present with such neurological symptoms as subtle transient myelopathy, tetraplegia, paresis, bulbar sign or central cord syndrome.
- Manual therapists should be trained to recognize this condition, educate patients and refer for medical/surgical consultation.
- The prevalence of this condition is not clear but the authors of this article refer to it as a rare condition.
Imaging is the needed to diagnose this condition and it may present in many ways.
I like the usefulness of imaging in the chiropractic practice. It would be really easy to take a shot at those who are reluctant to obtain imaging on patients by saying, look at this potentially serious problem you are missing. But that's not fair. I certainly don't like it when providers who feel radiography has very limited usefulness in a chiropractic practice criticize those who feel differently. We all have to look at each case individually and decide what is best for our patients. I'm going to close with one of my favorite quotes from the Handbook of Clinical Chiropractic by Lawrence H. Wyatt concerning diagnostic imaging, "Will the treatment or the prognosis for the patient change if this study is performed? If the answer is yes, then the study should be performed, barring any contraindications. If the answer is no, then serious thought should be given to other diagnostic studies that might be more helpful."
Reviewer: Roger Coleman DC
Editor: Mark R. Payne DC
Reference: Chrobak K, Larson R, Stern PJ. Varied clinical presentation of os odontoideum: a case report. J Can Chiropr Assoc. See comment in PubMed Commons below2014; 58:268-72
Link to Abstract: http://www.ncbi.nlm.nih.gov/pubmed/25202154
This is Dr. Coleman's 200th review article for Science In Brief.