{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T01:00:51Z","timestamp":1784682051442,"version":"3.55.0"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,7,20]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Retro-odontoid pseudotumors (ROPs) and subaxial cervical osteophytes are generally considered distinct causes of ventral neural compression. The authors hypothesize that both represent secondary changes related to underlying cervical spinal instability rather than primary pathological entities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>Between January 2022 and June 2025, 5 patients presented with coexisting ROP and multilevel subaxial osteophytes causing significant ventral dural compression. All patients underwent posterior stabilization of the atlantoaxial and involved subaxial segments aimed at achieving arthrodesis. No direct decompression, including resection of pseudotumor or osteophytes, was performed. All patients experienced immediate and sustained neurological improvement postoperatively. Follow-up imaging (\u2265 6 months) demonstrated solid stabilization and regression of both ROP and osteophytes. No patient required additional decompressive surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>ROP and subaxial osteophytes may represent reversible, secondary manifestations of cervical instability. Stabilization alone can result in both clinical recovery and radiographic resolution, potentially obviating the need for direct decompressive procedures. Recognition of instability as the primary pathology has important implications for surgical strategy.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26416\">https:\/\/thejns.org\/doi\/10.3171\/CASE26416<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26416","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:01:00Z","timestamp":1784678460000},"source":"Crossref","is-referenced-by-count":0,"title":["Retro-odontoid pseudotumor and subaxial spinal osteophytes: instability as the etiology and stabilization as the treatment. Illustrative cases"],"prefix":"10.3171","volume":"12","author":[{"given":"Atul","family":"Goel","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Lilavati Hospital and Research Center, Mumbai, Maharashtra, India"},{"name":"Department of Neurosurgery, K.J. Somaiya Hospital and Research Center, Ayurvihar, Mumbai, Maharashtra"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7381-4801","authenticated-orcid":true,"given":"Aimee","family":"Goel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospitals Birmingham, Birmingham NHS Foundation Trust, Birmingham, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhidha","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, Maharashtra"},{"name":"Department of Neurosurgery, K.J. Somaiya Hospital and Research Center, Ayurvihar, Mumbai, Maharashtra"},{"name":"Department of Neurosurgery, Apollo Hospitals Navi Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apurva","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lilavati Hospital and Research Center, Mumbai, Maharashtra, India"},{"name":"Department of Neurosurgery, K.J. Somaiya Hospital and Research Center, Ayurvihar, Mumbai, Maharashtra"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravikiran","family":"Vutha","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, K.J. Somaiya Hospital and Research Center, Ayurvihar, Mumbai, Maharashtra"},{"name":"Department of Neurosurgery, Apollo Hospitals Navi Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"11","key":"bib1","series-title":"Neurol Med Chir (Tokyo)","first-page":"603","article-title":"Atlantoaxial instability and retroodontoid mass\u2014two case reports","volume":"44","author":"Goel","year":"2004","unstructured":"Goel APhalke UCacciola FMuzumdar D.Atlantoaxial instability and retroodontoid mass\u2014two case reports. Neurol Med Chir (Tokyo). 2004;44(11):603-606. doi:10.2176\/nmc.44.603"},{"issue":"3","key":"bib2","series-title":"J Neurosurg Spine","first-page":"273","article-title":"Immediate postoperative regression of retroodontoid pannus after lateral mass reconstruction in a patient with rheumatoid disease of the craniovertebral junction. Case report","volume":"9","author":"Goel","year":"2008","unstructured":"Goel ADange N.Immediate postoperative regression of retroodontoid pannus after lateral mass reconstruction in a patient with rheumatoid disease of the craniovertebral junction. Case report. J Neurosurg Spine. 2008;9(3):273-276. doi:10.3171\/SPI\/2008\/9\/9\/273"},{"issue":"3","key":"bib3","series-title":"Neurol India","first-page":"338","article-title":"Craniovertebral realignment for basilar invagination and atlantoaxial dislocation secondary to rheumatoid arthritis","volume":"52","author":"Goel","year":"2004","unstructured":"Goel ASharma P.Craniovertebral realignment for basilar invagination and atlantoaxial dislocation secondary to rheumatoid arthritis. Neurol India. 2004;52(3):338-341."},{"key":"bib4","series-title":"World Neurosurg","first-page":"419","article-title":"Immediate postoperative disappearance of retro-odontoid \u201cpseudotumor\u201d","volume":"91","author":"Shah","year":"2016","unstructured":"Shah AJain SKaswa AGoel A.Immediate postoperative disappearance of retro-odontoid \u201cpseudotumor\u201d. World Neurosurg. 2016;91:419-423. doi:10.1016\/j.wneu.2016.04.050"},{"key":"bib5","series-title":"World Neurosurg","first-page":"614","article-title":"Muscle weakness-related spinal instability is the cause of cervical spinal degeneration and spinal stabilization is the treatment: an experience with 215 cases surgically treated over 7 years","volume":"140","author":"Goel","year":"2020","unstructured":"Goel ADandpat SShah ARai SVutha R.Muscle weakness-related spinal instability is the cause of cervical spinal degeneration and spinal stabilization is the treatment: an experience with 215 cases surgically treated over 7 years. World Neurosurg. 2020;140:614-621. doi:10.1016\/j.wneu.2020.03.104"},{"key":"bib6","series-title":"World Neurosurg","first-page":"e876","article-title":"Outcome of osteophytes after only-fixation as treatment for multilevel cervical spondylosis\u2014a minimum of 12 months follow-up","volume":"146","author":"Goel","year":"2021","unstructured":"Goel AVaja TShah AOutcome of osteophytes after only-fixation as treatment for multilevel cervical spondylosis\u2014a minimum of 12 months follow-up. World Neurosurg. 2021;146:e876-e887. doi:10.1016\/j.wneu.2020.11.032"},{"issue":"1-2","key":"bib7","series-title":"Acta Neurochir (Wien)","first-page":"47","article-title":"Plate and screw fixation for atlanto-axial subluxation","volume":"129","author":"Goel","year":"1994","unstructured":"Goel ALaheri V.Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien). 1994;129(1-2):47-53. doi:10.1007\/BF01400872"},{"issue":"6","key":"bib8","series-title":"Neurosurgery","first-page":"1351","article-title":"Atlantoaxial fixation using plate and screw method: a report of 160 treated patients","volume":"51","author":"Goel","year":"2002","unstructured":"Goel ADesai KIMuzumdar DP.Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurgery. 2002;51(6):1351-1357. doi:10.1097\/00006123-200212000-00004"},{"key":"bib9","series-title":"J Clin Neurosci","first-page":"9","article-title":"Report of an eight-year experience with Camille\u2019s transarticular technique of cervical spinal stabilization","volume":"95","author":"Goel","year":"2022","unstructured":"Goel ABiswas CShah ARai SDandpat SBhambere S.Report of an eight-year experience with Camille\u2019s transarticular technique of cervical spinal stabilization. J Clin Neurosci. 2022;95:9-19. doi:10.1016\/j.jocn.2021.11.024"},{"issue":"4","key":"bib10","series-title":"J Craniovertebr Junction Spine","first-page":"197","article-title":"Camille\u2019s transarticular technique of spinal fixation: an underused surgical technique","volume":"10","author":"Goel","year":"2019","unstructured":"Goel A.Camille\u2019s transarticular technique of spinal fixation: an underused surgical technique. J Craniovertebr Junction Spine. 2019;10(4):197-198. doi:10.4103\/jcvjs.JCVJS_120_19"},{"issue":"2","key":"bib11","series-title":"J Craniovertebr Junction Spine","first-page":"47","article-title":"Vertical facetal instability: is it the point of genesis of spinal spondylotic disease?","volume":"6","author":"Goel","year":"2015","unstructured":"Goel A.Vertical facetal instability: is it the point of genesis of spinal spondylotic disease? J Craniovertebr Junction Spine. 2015;6(2):47-48. doi:10.4103\/0974-8237.156031"},{"issue":"3","key":"bib12","series-title":"Neurosurg Focus","first-page":"E13","article-title":"Central or axial atlantoaxial dislocation and craniovertebral junction alterations: a review of 393 patients treated over 12 years","volume":"54","author":"Shah","year":"2023","unstructured":"Shah AVutha RPrasad AGoel A.Central or axial atlantoaxial dislocation and craniovertebral junction alterations: a review of 393 patients treated over 12 years. Neurosurg Focus. 2023;54(3):E13. doi:10.3171\/2022.12.FOCUS22634"},{"key":"bib13","series-title":"World Neurosurg","first-page":"e170","article-title":"Retro-odontoid and Retro-C2 body pseudotumor, pannus, and\/or cyst. A study based on analysis of 63 cases","volume":"151","author":"Goel","year":"2021","unstructured":"Goel ADarji HShah APrasad AHawaldar A.Retro-odontoid and Retro-C2 body pseudotumor, pannus, and\/or cyst. A study based on analysis of 63 cases. World Neurosurg. 2021;151:e170-e177. doi:10.1016\/j.wneu.2021.03.155"},{"issue":"1","key":"bib14","series-title":"Oper Neurosurg","first-page":"165","article-title":"Letter: Clinical and radiographic outcomes of atlantoaxial or occipitocervical fixation and fusion in patients with cervical myelopathy due to idiopathic retro-odontoid pseudotumor","volume":"29","author":"Goel","year":"2025","unstructured":"Goel A.Letter: Clinical and radiographic outcomes of atlantoaxial or occipitocervical fixation and fusion in patients with cervical myelopathy due to idiopathic retro-odontoid pseudotumor. Oper Neurosurg. 2025;29(1):165-166. doi:10.1227\/ons.0000000000001636"},{"issue":"1","key":"bib15","series-title":"J Craniovertebr Junction Spine","first-page":"6","article-title":"Retro-odontoid mass: an evidence of craniovertebral instability","volume":"6","author":"Goel","year":"2015","unstructured":"Goel A.Retro-odontoid mass: an evidence of craniovertebral instability. J Craniovertebr Junction Spine. 2015;6(1):6-7. doi:10.4103\/0974-8237.151578"},{"issue":"2","key":"bib16","series-title":"J Neurosurg Spine","first-page":"269","article-title":"Letter to the editor: retro-odontoid mass","volume":"26","author":"Goel","year":"2017","unstructured":"Goel A.Letter to the editor: retro-odontoid mass. J Neurosurg Spine. 2017;26(2):269-272. doi:10.3171\/2016.7.SPINE16801"},{"key":"bib17","series-title":"J Clin Neurosci","article-title":"Craniovertebral junction degenerative arthritis\u2014evolving understanding","volume":"142","author":"Goel","year":"2025","unstructured":"Goel AEl-Ghandour NMFShah ACraniovertebral junction degenerative arthritis\u2014evolving understanding. 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