Our surgeons are among the most experienced in the world in treating an array of neurosurgical conditions.
Read about our surgical team >
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.
Odontoid pannus can also develop as a result of severe trauma to the neck, at the second cervical vertebra.
A similar but rarely diagnosed condition is an odontoid synovial cyst, which has similar symptoms and treatment.
Rheumatoid arthritis (RA) is a progressive autoimmune disease that causes chronic inflammation of the joints. 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 rheumatoid arthritis 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 you suffer from spinal cord or brainstem compression, then we recommend surgery to decompress these vital neural elements.
At UPMC, the preferred surgical treatment 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.
EEA is an innovative, minimally invasive technique that uses the nose and nasal cavities as natural corridors to access hard-to-reach or previously inoperable conditions such as odontoid pannus. Benefits of EEA include:
Your physician may perform a physical exam and ask about symptoms.
Symptoms of odontoid pannus may include:
Your doctor will want you to have imaging tests such as CT or MRI scans to confirm the diagnosis.
If you have cervical instability and deformity as the result of odontoid pannus, but are 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. This state-of-the-art, minimally invasive approach allows surgeons to access the tissue through the natural corridor of the nose, without making an open incision.
EEA offers the benefits of no incisions to heal, no disfigurement, and a faster recovery time.
After endonasal decompression of the neural structures, you will need 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. Most people can go home immediately after EEA, depending on the healing of the fusion procedure.
UPMC's neurosurgical team carefully evaluates each patient — looking at your condition from every direction — to find a path that is the least disruptive to your brain, critical nerves, and ability to return to normal functioning.
How can we help you?
Schedule anappointment >
Ask a question >
Request our expertopinion >
1-877-986-9862(within the U.S.)
Affiliated with the University of Pittsburgh Schools of the Health Sciences
Supplemental content provided by
A.D.A.M. Health Solutions. All rights reserved.
For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.
UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.
Medical information made available on UPMC.com is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, UPMC.com is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.
For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. As such, UPMC Mercy neither endorses nor provides medical practices and/or procedures that contradict the moral teachings of the Roman Catholic Church.
Pittsburgh, PA, USA UPMC.com