Odontoid pannus is abnormal tissue that grows in the region of the odontoid process, a toothlike projection at the back of the second cervical vertebra. The odontoid process serves as the pivot point for turning the head.
This membrane of granulated tissue forms most often as a result of rheumatoid arthritis, in which the condition is called a rheumatoid pannus. Rheumatoid arthritis (RA), is a progressive autoimmune disease that causes chronic inflammation of the joints. Odontoid pannus can also develop as a result of severe trauma to the neck, where the second cervical vertebra is located. A similar, rarely diagnosed condition, is an odontoid synovial cyst, which has similar symptoms and treatment.
When rheumatoid arthritis attacks, it usually begins in the synovium, a type of tissue that lines the joint capsule. Cells in the synovium begin to grow and divide abnormally (synovitis) causing a thickening in the synovium, which results in an inflamed and swollen joint. As the disease progresses, the synovium may grow larger and form an inflamed, granulated sheet of tissue called rheumatoid pannus. This tissue will spread from the synovial membrane, causing considerable destruction as it invades the subchondral bone.
Symptoms of cervical–spinal abnormalities develop in approximately 60 to 80 percent of patients with Rheumatoid arthritis. When RA invades the cervical spine, the resulting extension of pannus into the spinal canal can compress the brainstem, spinal cord, and the vertebral arteries, resulting in severe pain and disability. Left untreated, rheumatoid pannus may even result in sudden death.
Progressive deformity is caused by instability of the joints. When there is no neurological compromise, the recommended treatment is cranio-cervical fusion to stabilize the joints. However, if a patient is suffering from spinal cord or brainstem compression, then surgery to decompress these vital neural elements is indicated.
The preferred surgical treatment at UPMC for spinal cord or brainstem compression caused by odontoid pannus, rheumatoid pannus, or synovial cyst is the Endoscopic Endonasal Approach (EEA) to decompress the brainstem and spinal cord. This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors to access hard-to-reach or previously inoperable tumors. EEA offers the benefits of no incisions to heal, no disfigurement to the patient, and a faster recovery time.
Your physician may perform a physical exam and ask about symptoms. Symptoms of odontoid pannus may include:
- pain, weakness, and difficulty in movement
- partial paralysis
- muscle wasting
Your doctor will want you to have imaging tests such as CT or MRI scans to confirm the diagnosis.
If the patient has cervical instability and deformity as the result of odontoid pannus, but is not having neurological compression, the recommended treatment is cranio-cervical fusion to stabilize the joints.
Surgical decompression is necessary if the spinal cord and brainstem are compressed. The Endoscopic Endonasal Approach (EEA) is a direct way to decompress the brainstem and upper spinal cord. By approaching the disease through the nose, patients will have a faster recovery and will be able to eat immediately after surgery.
After endonasal decompression of the neural structures, the patient needs a cranio-cervical fusion to prevent recurrence and promote stability of the joints to avoid further neurological deterioration. This fusion stabilizes the underlying problem that caused the compression.
Most of the time, the EEA procedure is extradural, meaning that the lining of the brain is not opened, and most patients can go home immediately, depending on the healing of the fusion procedure.
At UPMC, we take a 360° Approach to treatment when evaluating each patient—looking at their conditions from every direction—to find the path that is least disruptive to the patient’s brain, critical nerves, and ability to return to normal functioning. Our neurosurgical team may recommend a combination of surgical and non-surgical approaches to maximize the benefits of surgery while minimizing risks.