ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Postoperative changes in location and size of retro-odontoid pseudotumor after upper cervical fusion without decompression.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate the immediate postoperative changes in retro-odontoid pseudotumor (ROP) classified according to morphological characteristics following upper cervical fusion without decompression.
methodThis retrospective study analyzed 35 patients who underwent upper cervical fusion (C1-2 or occiput-cervical) for ROP between January 2020 and December 2023. ROPs were classified into solid and non-solid (mixed/cystic) types based on MRI signal characteristics. Radiological parameters including space available for cord (SAC), anterior atlantodental interval (AADI), and spinal cord compression were measured pre- and postoperatively. Clinical outcomes were assessed using visual analog scale (VAS), Japanese Orthopedic Association (JOA) score, and neck disability index (NDI).
resultsThe cohort comprised 15 patients with non-solid masses and 20 with solid masses. Non-solid masses demonstrated significantly greater SAC improvement (3.01 ± 1.81 mm vs. 0.94 ± 1.66 mm, p < 0.001) and AADI correction (3.25 ± 1.60 mm vs. 0.85 ± 1.67 mm, p < 0.001) compared to solid masses. All non-solid cases showed postoperative fluid migration (53.3% upward, 46.7% posterior), with no difference in outcomes based on migration direction. Both groups achieved comparable clinical improvements with improvement rates of 80.33% versus 82.0% respectively (p = 0.73).
conclusionsNon-solid ROPs exhibit superior radiological response to fusion without decompression compared to solid masses, likely reflecting their more reactive nature. Fluid migration following fusion represents a benign phenomenon that does not compromise clinical outcomes. These findings support fusion alone as an effective treatment strategy for appropriately selected patients with ROPs, particularly those with fluid-containing lesions.
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