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Vol. 15. Issue 6.
Pages 553-563 (January 2004)
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Vol. 15. Issue 6.
Pages 553-563 (January 2004)
Reducción de las masas periodontoideas tras artrodesis posterior: revisión a propósito de 2 casos no vinculados a artritis reumatoide
Reduction of periodontoid masses following posterior arthrodesis: two new cases not linked to rheumatoid arthritis review
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Mª.C. Joly-Torta
, S. Martín-Ferrer, J. Rimbau-Muñoz, C. Domínguez
Servicio de Neurocirugía. Hospital Universitario Dr. Josep Trueta. Gerona
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Resumen

La aparición de un “pannus” inflamatorio perio-dontoideo en pacientes afectos de artritis reumatoide, es sobradamente conocida. Menos frecuente es la existencia de masas periodontoideas, de aspecto similar al “pannus”, pero no vinculadas con la inflamación reumática.

La cirugía transoral asociada a artrodesis posterior se consideró durante mucho tiempo como una de las formas más eficaces para resolver el “pannus” en aquellos casos que se presentaban con deterioro neurológico secundario a esta masa de partes blandas.

Presentamos dos casos de desaparición de una lesión proliferativa alrededor de la apófisis odontoides mediante una artrodesis posterior occipito-cervical. Se trataron dos mujeres de 67 y 60 años respectivamente, con clínica de dolor y deterioro neurológico progresivo. Existían antecedentes de una posible fractura antigua de odontoides en un caso, y de una artrodesis cervical anterior amplia por espondiloartrosis en el otro. Ambos pacientes mejoraron neurológicamente después de una artrodesis por vía posterior.

Palabras clave:
Masa o “pannus” periodontoideo
Luxación C1–C2
Artrodesis transarticular C1–C2
Abreviaturas:
AR
Summary

Inflamatory periodontoid pannus is quite common in patients with rheumatoid arthritis. However, the occurrence of a pannus-like periodontoid mass that is unassociated with rheumatic inflammation is less frequent.

Transoral surgery associated with a posterior stabilization has long been considered one of the most efficient methods to resolve the problem of instability in patients presenting neurological déficits secondary to the pannus.

We present two cases of non rheumatic etiology, in which an occipito-cervical arthrodesis was used to resolve the proliferative lesión around the odontoid apophysis. Two women (67 and 60 years oíd respectively) presented symptoms of pain and neurological deterioration with an antecedent of possible past odontoid fracture in one case, and a previous large anterior cervical arthrodesis to correct spondylarthrosis in the other case. Both patient's neurological condition improved after placement of an arthrodesis through a posterior approach.

Key words:
Periodontoid mass or pannus
Atlantoaxial subluxation
Transarticular C1–C2 screw fixation

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